Diabetes (Type II) and Diet
Diabetes is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin production,
insulin action or both. The number of Americans with diagnosed diabetes
is projected to increase 165%, from 11 million in 2000 to 29 million in
2050 (prevalence change from 4% to 7%). This increase is attributed to
changes in the demographics of our population but also reflects changes
in obesity and lifestyle factors [1].
Risk factors for type 2 diabetes include: 1) family history, 2) increased
waist circumference, and 3) increased body
mass index (BMI). Type 2 diabetes is diagnosed by: 1) symptoms of
diabetes (polyuria, polydipsia, and unexplained weight loss) or 2) elevated
causal plasma glucose of >200 mg/dl, or 3) repeated fasting serum glucose
of >126 mg/dl. Diabetes is considered an independent risk factor for
cardiovascular disease.
Current national recommendations on diabetes focus on the treatment of
type 2 diabetes with medications, control of diet and exercise to match
medications, and control of serum glucose levels to <96 mg/dl using
frequent monitoring via a glucometer with subsequent control of hemoglobin
A1C
(A1C) to <6.8% [2].
The current literature indicates that interventions in persons with diabetes,
to control blood sugar and decrease serum A1C, have only met with moderate
success. Studies report an average of a 1% drop in A1C while levels of
at least a 2% are recommended to observe a clinically significant decrease
in risk and progression of disease [3].
A recent study in persons at increased risk for type 2 diabetes (due to
an abnormal glucose tolerance test) reported that lifestyle intervention
in this group of subjects resulted in a reduction of progression to type
2 diabetes of 58% compared to the control group [2].
In contrast, those persons randomized to treatment with medication, metformin,
an insulin sensitizer, only showed a 31% reduction in progression to type
2 diabetes. This study has focused considerable attention on the importance
of diet and exercise to prevent the development of type 2 diabetes.
A number of dietary changes have been reported to decrease serum glucose
and insulin. Among these are: a high fiber diet [4],
a diet with a low glycemic
load [5]
and a diet high in n-3 fatty acids [6].
This approach to dietary intervention for the prevention and treatment
of type 2 diabetes focuses on both the amount and type of carbohydrate
and fat consumed [7].
Utilization of a diet that takes advantage of all of the currently identified
factors has not been adequately tested at this time.
The American Diabetes Association
website has useful patient and physician information. An article by Messing
discusses standards for diabetes self-management education and provides
materials for use in patient sessions [8].
Patients generally require additional sessions with a nutritionist/dietitian
in order to make significant lifestyle changes in diet to decrease their
A1C and the progression of their disease. Dietary and exercise changes
are needed to minimize the use of medications that will normally increase
in dose if lifestyle changes are not made. Insulin resistance will progress
with the disease in the absence of significant lifestyle change of diet,
weight or exercise and with increasing dosing of medications and insulin.
Resources and Links: Diabetes Diet Interventions
- American Diabetes Association Diet
- Pritikin High Fiber Diet
-
What
is the Glycemic Index and Is it a Helpful Tool?
Joslin Diabetes Center
Resources and Links: Diabetes as a Condition
- Diabetes
National Institute of Diabetes & Digestive & Kidney Diseases - Diabetes Public Health Resource
National Center for Chronic Disease Prevention and Health Promotion
NCCAM