Diabetes Type 2 Treatment Diet – Nutrition Science and Policy Analysis Dietary and Nutritional Approaches to Preventing and Treating Type 2 Diabetes 2018; 361 doi: https://doi.org/10.1136/.k2234 (Published 13 Jun 2018) Cite this as: 2018;361:k2234 Food for thought Click here to read other articles in this collection
Common ground may be found in nutritional approaches to the prevention, treatment and possible remission of type 2 diabetes, say Nita G Forouhi and colleagues.
Diabetes Type 2 Treatment Diet
Dietary factors play an extremely important role in the treatment and prevention of type 2 diabetes. Despite progress in developing evidence-based dietary guidelines, controversy and uncertainty remain. In this article, we examine the evidence for areas of consensus as well as ongoing uncertainty or controversy regarding dietary guidelines for type 2 diabetes. What is the best nutritional approach? Is it possible to achieve remission of type 2 diabetes through lifestyle changes, or is it inevitably a condition that leads to progressive health deterioration? We also examine the effects of dietary transitions and population-specific factors in a global context and discuss future directions for and implementation of effective dietary and nutritional approaches for the treatment of type 2 diabetes.
Plants As Treatment For Type 2 Diabetes
Diabetes is one of the major global public health problems: prevalence is estimated to increase from 425 million people in 2017 to 629 million by 2045, with associated health, social and economic costs.1 Urgent solutions to slow or even reverse this problem. trends are needed, particularly from investments in modifiable factors including diet, physical activity, and weight. According to the Global Burden of Disease Study conducted in 188 countries, diet is a major contributor to morbidity and mortality worldwide.2 The importance of diet in the treatment and prevention of type 2 diabetes through its effects on weight and metabolic control is clear. However, diet is also one of the most controversial and difficult aspects of treating type 2 diabetes.
The idea of going on a “diet” for a chronic illness like diabetes is enough to put off many people, as knowing what to eat and maintaining an optimal eating pattern is a challenge. Medical nutrition therapy was introduced to guide a systematic and evidence-based approach to the management of diabetes through diet, and its effectiveness has been demonstrated 3 , but difficulties remain. Although most diabetes guidelines recommend starting pharmacotherapy only after lifestyle changes in diet and physical activity have been implemented, this is not universally followed in practice. Most physicians are not trained in nutritional interventions, and this is a barrier to counseling patients.45 In addition, talking to patients about nutrition is time-consuming. In many settings outside of specialized diabetes centers where trained nutritionists/educators are available, dietary advice for diabetics is at best a printed menu given to the patient. In resource-poor settings, when type 2 diabetes is diagnosed, the patient often leaves the clinic with a new list of medications and little else. There is wide variation in the use of dietary modification alone to treat type 2 diabetes: for example, less than 5–10% of patients with type 2 diabetes are reported in India6 and 31% in the UK, although patients are treated with lifestyle. measures may be less rigorously managed than patients taking type 2 diabetes medications.7 Although systems are generally in place to record and monitor process steps for diabetes care in the medical record, nutritional information is often neglected, even though diet is the focus at least some attention. necessary to achieve adequate glycemic control. GPs and hospital clinics should collect this information regularly, but how to do so is a challenge.58
Progress has been made in understanding the best dietary recommendations for diabetes, but there are broader challenges. For example, most dietary guidelines recommend increasing vegetable and fruit intake, but the cost is prohibitive in many settings: the cost of two servings of fruit and three servings of vegetables per day per individual (to meet the “5 a day” guidelines) was 52%, 18 respectively. %, 16% and 2% of household income in low-, middle-, middle- and middle-income countries.9 An expensive food market labeled for use by people with diabetes also exists, and the products are often no healthier and sometimes less healthy than conventional food. Following new European Union legislation, food regulations in some countries, including the UK, were updated as recently as July 2016 to ban such misleading labels. Elsewhere, however, this is not the case, and it is unclear what will happen to such regulation after the UK leaves the European Union, underscoring the importance of the political environment.
In some, mainly developed countries, dietary guidelines for the treatment of diabetes have evolved from a focus on a low-fat diet to the recognition that more important considerations are the quality of macronutrients (that is, the type and amount of macronutrients), the avoidance of processed foods (especially processed starches and sugars ) and overall dietary patterns. Many systematic reviews and national dietary guidelines have evaluated the evidence for optimal dietary advice, and we will not repeat the review of the evidence.101112131415161718 Instead, in the following sections, we address some important principles on which there is broad consensus in the scientific and clinical communities and highlight areas. uncertainties, but we begin by outlining three basic features.
Condiments And Spices For The Diabetes Diet
First, understanding of a healthy diet for the prevention and treatment of type 2 diabetes is largely derived from long-term prospective studies and limited evidence from randomized controlled trials in general populations, supplemented by evidence from people with type 2 diabetes. Many published guidelines and reviews have applied assessment criteria, and this evidence is often of moderate quality in a hierarchy of evidence, with randomized controlled trials at the top. Elsewhere, it has been argued that evidence-based dietary guidelines should collectively use a variety of evidence that assesses consistency across multiple study designs, including large population-based prospective clinical end point studies, controlled crossover studies, and randomized clinical end point studies where possible. 19
Second, it is now recognized that dietary recommendations for both the prevention and treatment of type 2 diabetes need to converge and not be seen as separate entities (Figure 1). However, for those with type 2 diabetes, the degree of glycemic control and the type and dose of diabetes medication must be coordinated with diet.12 With some dietary interventions, such as very low-calorie or low-carbohydrate diets, people with diabetes usually stop. or reduce diabetes medication and be closely monitored as described in the next section.
Third, while recognizing the importance of diet in weight control, there is now a greater understanding 10 of the multiple pathways through which dietary factors influence health through both obesity-dependent and obesity-independent mechanisms. Dietary effects on weight, glycemia, and glucose-insulin homeostasis are directly related to glycemic control in diabetes, while other outcomes, such as cardiovascular complications, are further influenced by dietary effects on blood lipids, apolipoproteins, blood pressure, endothelial function, thrombosis, coagulation, systemic inflammation and vascular adhesion. The effects of food and nutrients on the gut microbiome may also be important in the pathogenesis of diabetes, but further research is needed. Therefore, the quality and quantity of nutrition is important in the long term for the prevention and treatment of diabetes and its complications through a wide range of metabolic and physiological processes.
Type 2 diabetes is most often associated with being overweight or obese and insulin resistance. Therefore, reducing weight and maintaining a healthy weight is a key component of clinical management. Weight loss is also associated with improvements in glycemia, blood pressure, and lipid levels, and thus may delay or prevent complications, especially cardiovascular events.
Shopping List For Diabetics
Most guidelines recommend promoting weight loss in overweight or obese people by reducing energy intake. Portion control is one strategy to limit energy intake along with a healthy eating pattern that focuses on a diet consisting of whole or unprocessed foods combined with physical activity and ongoing support.
Evidence suggests that food intake patterns high in vegetables, fruit, whole grains, legumes, nuts and dairy products such as yogurt are encouraged, but with some caution. First, some nutritional approaches (such as low-carb diets) recommend limiting fruit, whole grains, and legumes because of their sugar or starch content. The opinions of scientists and clinicians about fruit intake, especially for those with diabetes, are divided (see Appendix). However, many guidelines still recommend fruit on the basis that fructose intake from fruit is superior to isocaloric intake of sucrose or starch due to the additional micronutrient, phytochemical, and fiber content of fruit. Second, despite evidence from randomized controlled trials and prospective studies10 that nuts may help prevent type 2 diabetes, there is some (perhaps misplaced) concern about their high energy content. Further research in people with type 2 diabetes should help clarify this.
There is also consensus on the benefits of certain named dietary patterns, such as the Mediterranean diet, for the prevention and treatment of type 2 diabetes. Expert guidelines also support other healthy eating patterns that take into account local socio-cultural factors and personal preferences.
There is consensus on reducing or avoiding consumption of processed red meat, refined grains
Risk Factors And Diabetes: Type 1, Type 2, And Gestational
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