Diabetes mellitus (DM) remains a global problem. The International Diabetes Federation predicts a 129% increase in people living with diabetes in Africa. Careful management of DM is essential to prevent complications and death. In 2021 alone, diabetes was responsible for 6.7 million deaths.
Diet is an essential component of DM management. Most guidelines recommend dietary and lifestyle changes first before the addition of drugs. But in practice, many doctors administer drugs without implementing dietary management strategies.
Research suggests that many doctors need to be adequately trained to offer support. Unfortunately, primary care physicians often work in settings where access to nutritionists is limited.
In this blog post, you will learn about the dietary management of diabetes. It is important to note the critical role of the nutritionist in diabetes management. So, when available, it’s best to refer patients for nutritional counselling.
Goals of dietary management of DM
The pharmacological management of DM is highly individualized, which also applies to dietary management. When tackling diet, it is essential to consider
- Patient’s preference
- Patient’s culture
- Comorbid conditions
- Health literacy
- Availability of food
- Socioeconomic factors
- Willingness to make changes
- Barriers to making changes
Strategies that do not consider the factors mentioned above are likely to fail. The truth is that it’s challenging to maintain any diet for a long time. So, it is essential to customize every plan for each patient as this increases the chances of success.
The goals of dietary changes are to
- Achieve target body weight
- Achieve glycemic control
- Achieve lipid control
- Achieve blood pressure control
- Prevent diabetes complications
- Choose foods that are enjoyable but healthy to eat
Approach to dietary management of DM
Patients with DM should be educated on what to eat, how much, and how often. Discourage binge eating. Any approach employed should consider patient factors. Furthermore, meal planning should be affordable and incorporate cultural eating patterns. Finally, it is essential to ensure meals are palatable and maintain the pleasure of eating.
Patients who are overweight or obese would need a deficit in their caloric intake since achieving and maintaining a target body weight is a vital treatment goal. Several diet plans have been widely publicised, like the Mediterranean diet, low-carb diets, and low-fat/high-protein diets. Although no particular diet is recommended for patients with diabetes, weight loss interventions can improve glycemic control and lipid profile. Furthermore, several diets, like the Mediterranean diet, vegan and Dietary Approach to Stop Hypertension (DASH) diet, have been shown to confer a lower risk of DM.
According to the American Diabetes Association, current evidence suggests no ideal percentage of calories from carbohydrates, protein, and fat for all people with diabetes. The best eating pattern combines food from all groups. Nutrient-dense meals are encouraged. Overall, portion control with reduced energy intake appears to be a good strategy for people who are overweight and obese. Weight loss strategies should include diet and exercise.
However, take care when instituting dietary restrictions in specific individuals.
- Pregnant women
- Lactating mothers
- People with a history of an eating disorder
Carbohydrates
According to the Type 2 Clinical Practice Guidelines for Sub-Saharan Africa, the caloric restriction should be tailored to ensure balanced nutrition. In general, it may be best to reduce carbohydrates. Encourage carbohydrates from vegetables, legumes, whole grains, and fruit. Many patients do not realize that legumes are a source of carbohydrates and may over-eat. This is where portion control is important. Vegetables and grains are rich in fiber. One resource describes dietary fibers as “the carbohydrate and lignin found in plants that are not digested by the stomach or absorbed in the GI tract.” Eating a meal with high fiber promotes satiety and reduced calorie intake.
Encourage patients to avoid processed carbohydrates, especially sweetened beverages. According to a report, some people succeed in reducing sugar intake by using low-calorie and non-nutritive sweeteners. Non-nutritive sweeteners provide a sweet sensation without compromising blood sugar. When selecting a sweetener, it is advisable to use sweeteners approved by regulatory bodies as these are shown to be safe.
Proteins
In general, there’s no need to adjust protein in patients with diabetes except if they have kidney disease. Lean meat, nuts, nut butter, fish, and skinless poultry are excellent sources of protein.
Fats
The type of fat eaten in meals is important. Higher cholesterol and saturated fat consumption are associated with a greater cardiovascular risk. Several guidelines recommend limiting saturated fat intake, especially those from industrial hydrogenation (trans fat). The American Heart Association recommends that only 5-6% of total calories should be from saturated fats. Sources of saturated fats are
- Butter
- Sausages
- Palm oil
- Coconut oil
- Fatty meat
Cutting back on fast foods, processed foods, and meats is a great way to limit saturated fat consumption.
Most of the fat eaten should be from mono- and polyunsaturated fats. Fatty fish, nuts, and nut butter are good sources of monounsaturated fats. On the other hand, fish, walnuts, and vegetable oils like olive oil, soybean oil, and corn oil are good sources of polyunsaturated fat.
Vitamins and minerals
Vitamins and minerals play a vital role in overall health. Because sodium is implicated in fluid retention and hypertension, limiting intake is best.
Summary of strategies
- Take more complex carbohydrates
- Chose whole grains over refined grains
- Include a variety of vegetables in meals daily
- Limit intake of sweetened beverages and added sugars
- Limit processed meats and pastries
- Eat a low-salt diet
- Fat intake should consist mainly of unsaturated fats
- Limit consumption of saturated fat
Conclusion
Dietary management remains one of the cornerstones of DM management. Tailoring any recommendation to the patient’s culture, eating pattern, preferences, and socioeconomic status is advisable. Encourage the consumption of whole grains, vegetables, complex carbohydrates, and fruits. Discourage the intake of processed foods and meat. Continually educate the patient in a non-judgmental manner and encourage the use of other lifestyle modifications.
To learn more about dietary management of DM:
Click here for the Mayo Clinic diabetes diet and creating a healthy eating plan
Click here for Eat Well from the Centers for Disease Control and Prevention
Where available, it is advised to follow the Ministry of Health guidelines in your local setting.
Nwamaka Osakwe, FWACP, MBBS, is an award-winning physician who loves writing about health and wellness. You can reach her here.
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