The evolution of the nutritional management of diabetes

Abstract

Diet and lifestyle advice for individuals with diabetes has changed dramatically. The changes in nutritional recommendations have largely been in response to advances in the knowledge of the biochemical and physiological mechanisms of impaired glucose metabolism and the microand macrovascular complications of diabetes. The most recent guidelines for the nutritional management of diabetes were set out by Diabetes UK in 2003. This consensus-based advice paper builds on the previous evidence-based review papers of the European Association for the Study of Diabetes in 2000 and the American Diabetes Association in 2002. The changes from previous recommendations include a more liberal use of sucrose, in line with healthy eating recommendations for the general population, and allow for greater flexibility in energy derived from carbohydrate and monounsaturated fat. In addition, monounsaturated fats are promoted as the fat of choice and active promotion of carbohydrate foods with a low glycaemic index is encouraged. These guidelines emphasise the practical application of nutritional management of diabetes and the need to provide education and support in a structured way that will facilitate change in diet and lifestyle behaviour. Structured educational programmes have been shown to be effective in reducing the progression to diabetes and also in slowing the onset and progression of the complications of diabetes. These programmes require ongoing intensive input to maintain behavioural change in diet and lifestyle. Considerable energy and resources are required to set up and maintain these educational programmes, but the cost per individual is small compared with the costs of treating the complications of diabetes.

Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?

“…Diabetes mellitus has long been considered a disease of carbohydrate metabolism, and before the discovery of insulin in 1921, low carbohydrate starvation diets were the default treatment [ 1 ]. From the 1930s through to the 1960s, many experts continued to advise strict carbohydrate restriction, with the result that most people with diabetes adopted a high fat, low carbohydrate diet [ 2 ]. However, some early work in the 1920s and 1930s had suggested that high carbohydrate diets improved glucose tolerance, and the dramatic increase in deaths from vascular disease in those whose lives were prolonged by insulin treatment led to a volte-face in the 1980s, with authorities now recommending low fat, high carbohydrate diets [ 3 ].…”

Specific Dietary Carbohydrates Differentially Influence the Life Span and Fecundity of Drosophila melanogaster

“…Excessive carbohydrates, when acting as signaling molecules, may change the overall metabolic balance by affecting lipid and protein biosynthesis (8,9). Nevertheless, the contribution of particular carbohydrates to specific pathological states remains a hotly debated topic, with some reports remaining controversial (5,10).…”

“…Many carbohydrates induce changes in metabolism and development of diseases when overconsumed. It was shown that fructose in high doses may lead to obesity and metabolic syndrome (4), high intake of glucose compromises the health of diabetic patients (5), and galactose can accelerate ageing (6). Many mechanisms may account for the toxicity of carbohydrates at overconsumption.…”

Periodic 48 h feed withdrawal improves glucose tolerance in growing pigs by enhancing adipogenesis and lipogenesis

“…Although, it has been cited [29] that periodic fasting as a means of extending the lives of diabetics was attempted in the early part of the last century, with marginal success it has never been scientifically evaluated. The present study indicates that the adipose tissue expandability [17] especially of the OM [1] required to abate metabolic syndrome symptoms resides in the cells in the diameter range of 90 to 118 μm and maintenance of this expandability perhaps is possible through regular and periodic FW for 24 to 48 h.…”