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DIETARY GUIDELINES FOR PEOPLE WITH DIABETES

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As discussed in this month’s What’s New? the American Diabetes Association publishes evidence-based recommendations for the management of diabetes each year. While not published annually, Diabetes Canada and DiabetesUK also regularly conduct systematic literature reviews and publish evidence-based recommendations for the nutritional management of diabetes (1-5).

It’s important to note that all organisations recommend that people with diabetes or those at risk should be referred for individualized medical nutrition therapy (MNT) provided by an Accredited Practising/Registered Dietitian.

While the wording varies, all essentially state that there is no single eating pattern recommended for all people with diabetes, and that macronutrient (protein, fat and carbohydrate) distribution can be flexible, within recommended ranges, and should depend on individual treatment goals and food preferences. Overall, they recommend food-based dietary patterns that emphasize key nutrition principles like the regular consumption of non-starchy vegetables, whole fruits, legumes, whole grains, nuts/seeds, and lower-fat dairy products and minimize consumption of processed meats, sugar-sweetened beverages and refined grains/starches. Examples of healthy eating patterns for diabetes include Mediterranean-style, vegetarian, vegan, low-fat, low-carbohydrate, low-energy and very low-energy.

Overarching principles include:

  • Promoting healthy eating patterns, emphasizing a variety of nutrient-dense foods in appropriate sizes to improve overall health and to improve glycated haemoglobin (HbA1c), blood pressure, cholesterol and triglycerides and aid in achieving and maintaining body weight.
  • Individualize nutrition needs based on personal and cultural preferences, health literacy, and access to healthy food choices.
  • For those using exogenous insulin, focus on matching insulin doses with meal composition through carbohydrate counting.
Following these MNT guidelines under the guidance of an Accredited Practising/Registered Dietitian will help achieve absolute HbA1C reductions of 1.0–1.9% points for people with type 1 diabetes and 0.3–2.0% for people with type 2 diabetes.
Additionally, the Canadian and UK Guidelines specifically recommend replacing high glycemic index (GI) carbohydrates with low GI carbohydrates in mixed meals as this has been shown to have clinically significant benefits for people with type 1 and type 2 diabetes (6) in addition to that achieved with conventional healthy diets and carbohydrate counting (7), including an additional decrease in HbA1c of 0.31% points and reductions in fasting glucose (-0.36 mmol/L), LDL-Cholesterol (-0.17 mmol/L), non-HDL-Cholesterol (-0.20 mmol/L), triglycerides (-0.09 mmol/L), body weight (-0.66 kg), and body mass index (-0.38 kg/m2).

Diabetes-specific dietary guidelines are published by major diabetes associations around the world on a regular basis and overall, they all provide very similar recommendations, because they are based on the same high-quality scientific evidence. The overall benefits of healthy eating can often equal those achieved with pharmacological interventions without the unwanted side effects.

Read more:

  1. Sievenpiper and colleagues. Nutrition Therapy. Can J Diabetes. 2018.
  2. Holt and colleagues. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2021.
  3. National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management. United Kingdom: National Institute for Health and Care Excellence (NICE), 2022.
  4. Evert and colleagues. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014.
  5. Evert and colleagues. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019.
  6. Chiavaroli and colleagues. Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ. 2021.
  7. Bell and colleagues. Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2014.

Dr Alan Barclay, PhD, is a consultant dietitian and chef with a particular interest in carbohydrates and diabetes. He is author of Reversing Diabetes (Murdoch Books), and co-author of 40 scientific publications, The Good Carbs Cookbook (Murdoch Books), Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment Publishing).

Contact: Follow him on Twitter, LinkedIn or check out his website.
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