first, let me place a disclaimer..... the condition of type 2 causes the weight gain!!!!!
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www.diabetes.org.uk/Documents/Reports/Nu...elines200911.pdf>
Glycaemic control and Type 2 diabetes Recommendations
Weight management should be the primary nutritional strategy in managing glucose control in Type 2 diabetes for people who are overweight or obese.
Regular, moderate physical activity can reduce HbA1c by 0.45 - 0.65 per cent independent of weight loss.
Focus should be on total energy intake rather than the source of energy in the diet (macronutrient composition) for optimal glycaemic control.
The total amount of carbohydrate consumed is a strong predictor of glycaemic response and monitoring total carbohydrate intake whether by use of exchanges, portions or experience-based estimation, remains a key strategy in achieving glycaemic control.
Low GI diets may redcue HbA1c up to 0.5 per cent .
Weight management
Between 80 and 90 per cent of people with Type 2 diabetes are overweight and approximately 60 -90 per cent of Type 2 diabetes is obesity related [98, 99].
Weight loss is important in people with Type 2 diabetes who are overweight or obese and should be the primary management strategy.
Physical Activity
Physical activity has clear benefits on cardiovascular risk reduction and glycaemic control in people with Type 2 diabetes, with a meta-analysis reporting a mean weighted reduction of 0.45 per cent [106] to 0.65 per cent [107] in HbA1c
Diet
There is little evidence for the ideal macronutrient composition of the diet in the management of hyperglycaemia in Type 2 diabetes.
Small, short term intervention studies investigating the relationship between macronutrients and glycaemic control have reported contradictory results
Carbohydrate
Although the total amount of carbohydrate ingested is the primary determinant of post-prandial blood glucose response, there is little evidence to support specific strategies for recommendations about carbohydrate intake in Type 2 diabetes.
Low-fat diets
This strategy is the most widely employed in research studies and has generated the greatest amount of evidence [88].
A recent large trial in the United States has shown that lifestyle interventions, including a low-fat diet, significantly reduced body weight, HbA1c and cardiovascular risk factors and these positive changes could be maintained over four years
Low-carbohydrate diets
Low-carbohydrate diets have created some controversy, but both a recent review and meta analysis suggest that they are associated with significant reductions in body weight and improvements in glycaemic control [121, 135].
It has been shown that the main mode of action of low carbohydrate diets is simply a reduction in energy intake due to carbohydrate restriction [136].
Systematic reviews have reported that although these diets may be more effective than comparison diets over the short-term, there is little published evidence from studies in people without diabetes showing benefit over the longer term [44, 137]. Concern has been expressed about the potential adverse effects of these diets, especially on cardiovascular risk, but there remains no evidence of harm over the short term [137]
There has and continues to be research into a range of micronutrients, supplements and functional foods (eg vitamin B3, chromium, magnesium, anti-oxidants, vitamin D, zinc, caffeine, cinnamon, chilli, karela and methi) and their effect on diabetes management or their association in causing the onset of diabetes.
However, there is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes (compared with the general population), who do not have underlying deficiencies [42]. There are varying degrees of evidence from a range of studies looking into other supplements and functional foods. More robust research is required into micronutrients, supplements and functional foods before further recommendations about safety and effectiveness can be made.
Diabet Med. 2011 Nov;28(11):1282-8. doi: 10.1111/j.1464-5491.2011.03371.x.
Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.
Abstract
This article summarizes the Diabetes UK evidence-based guidelines for the prevention of Type 2 diabetes and nutritional management of diabetes. It describes the development of the recommendations and highlights the key changes from previous guidelines. The nutrition guidelines include a series of recommendations for the prevention of Type 2 diabetes, nutritional management of Type 1 and Type 2 diabetes, weight management, management of microvascular and macrovascular disease, hypoglycaemia management, and additional considerations such as nutrition support, end-of-life care, disorders of the pancreas, care of the older person with diabetes, nutrition provided by external agencies and fasting. The evidence-based recommendations were graded using the Scottish Intercollegiate Guidelines Network methodology and, in a small number of topic areas, where strong evidence was lacking, the recommendations were reached by consensus. The Diabetes UK 2011 guidelines place an emphasis on carbohydrate management and a more flexible approach to weight loss, unlike previous guidelines which were expressed in terms of recommendations for individual nutrient intakes. Additionally, the guidelines for alcohol have been aligned to national recommendations. The full evidence-based nutrition guidelines for the prevention and management of diabetes are available from:
www.diabetes.org.uk/nutrition-guidelines.
C 2011 Diabetes UK. Diabetic Medicine C 2011 Diabetes UK.
PMID: 21699560
