Individual approach in new diabetes nutrition guidance
16th March 2018 -- 'One size of diet does not fit all' was the core message from experts who have compiled the 2018 Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. They were speaking at the recent Diabetes UK Professional Conference 2018.
The guidelines, which provide an update to the 2011 version, were prepared earlier than the usual 10-year gap because of the wealth of data and extent of change in the field of diabetes in recent years, say the researchers.
Introducing the new guidelines were Dr Pamela Dyson, from Oxford University, and Douglas Twenefour, registered dietitian and deputy head of care at Diabetes UK. A summary was published online in Diabetic Medicine, and the full guidelines are available on the Diabetes UK website.
The guidelines cover education and care delivery, prevention of type 2 diabetes, glycaemic control for type 1 and type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, and other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods, and nutritive and non-nutritive sweeteners. They cover adults with diabetes as, for children, Diabetes UK has adopted guidelines by the International Society of Paediatric and Adolescent Diabetes (ISPAD).
Of note, recommendations are made in terms of 'foods' rather than nutrients wherever possible. Evidence around physical activity and alcohol intake, where appropriate, are included, as is information on how the guidelines can be best delivered and the role of dietitians, said Douglas Twenefour.
He pointed out that the individualised approach, epitomized in the new guidelines, was a key recommendation that extends to diet, physical activity, and surgical and medical strategies for people with diabetes.
Particularly noteworthy in the new 2018 guidelines is the recommendation for weight loss soon after diagnosis of type 2 diabetes in the hope of inducing remission, as well as a long section on diabetes in ethnic minorities.
"These groups have not received much attention in the past, due to very few randomised controlled trials to inform recommendations," remarked Dr Dyson. "We know ethnic minorities in the UK, in particular South Asian and [African-Caribbean] groups, are three to four times as likely as whites to get type 2 diabetes."
The guidelines also recognise that patients with type 2 diabetes are living longer and therefore experiencing more chronic diseases that would also benefit from a healthier diet, she noted. "For type 2 diabetes, we aim for weight loss, improving glycaemic control, and improving cardiovascular disease risk."
Nutrition can be a stand-alone therapy, although not for type 1 diabetes, which requires insulin and lifestyle interventions, she stressed.