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Diabetes Epidemiology, Genetics, Pathogenesis, Diagnosis, Prevention, and Treatment pp 497–512Cite as

Treatment of Diabetes with Lifestyle Changes: Diet

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Part of the book series: Endocrinology ((ENDOCR))

Abstract

The present chapter critically reviews scientific evidence on the impact of the diet and its components on the metabolic control, cardiovascular risk factors, and morbidity/mortality in diabetic patients.

Three main topics are included in this chapter: (1) the effects of dietary treatment on body weight control in diabetic patients; (2) the optimal dietary composition in order to achieve blood glucose control and reduce other cardiovascular risk factors associated with type 2 diabetes; (3) the effects of lifestyle modifications and dietary changes on the risk to develop type 2 diabetes.

The overall body of evidence seems to confirm the efficacy of current recommendations for diabetes management. However, although dietary strategies based on structured interventions are often successful, particularly in relation to body weight control, they are not easily applicable in clinical practice and, therefore, more feasible strategies should be identified.

In addition, further intervention studies focused on the effects of lifestyle on hard endpoints in diabetic subjects are needed to definitively prove the role of diet in the prevention of both cardiovascular and microvascular complications in these patients over and above their impact on weight reduction.

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Abbreviations

BMI:

Body Mass Index

CVD:

Cardiovascular diseases

DPS:

Diabetes Prevention Study

EASD:

European Association for the Study of Diabetes

T2D:

Type 2 diabetes

HDL-chol:

High density lipoprotein-cholesterol

MedD:

Mediterranean diet

NHANES:

National Health and Nutrition Examination Survey

References

  • Adler AI, Boyko EJ, Schraer CD, et al. Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska natives. Diabetes Care. 1994;17:1498–501.

    Article  CAS  Google Scholar 

  • American Diabetes Association. Standards of medical care in diabetes – 2017. Diabetes Care. 2017;40(Suppl 1):S1–S135.

    Google Scholar 

  • Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care. 2008;31(12):2281–3.

    Article  Google Scholar 

  • Bansal S, Buring JE, Rifai N, et al. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007;298(3):309–16.

    Article  CAS  Google Scholar 

  • Bassler D, Briel M, Montori VM, et al. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA. 2010;303:1180–7.

    Article  CAS  Google Scholar 

  • Bell KJ, Bao J, Petocz P, Colagiuri S, Brand-Miller JC. Validation of the food insulin index in lean, young, healthy individuals, and type 2 diabetes in the context of mixed meals: an acute randomized crossover trial. Am J Clin Nutr. 2015;102(4):801–6.

    Article  CAS  Google Scholar 

  • Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2003;26(8):2261–7.

    Article  Google Scholar 

  • Brand-Miller JC, Stockmann K, Atkinson F, Petocz P, Denyer G. Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: analysis of a database of more than 1,000 foods. Am J Clin Nutr. 2009;89(1):97–105.

    Article  CAS  Google Scholar 

  • Cespedes EM, Hu FB, Tinker L, et al. Multiple healthful dietary patterns and type 2 diabetes in the women’s health initiative. Am J Epidemiol. 2016;183:622–33.

    Article  Google Scholar 

  • Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M, STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359(9323):2072–7.

    Article  CAS  Google Scholar 

  • Coppell KJ, Kataoka M, Williams SM, et al. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment–lifestyle over and above drugs in diabetes (LOADD) study: randomised controlled trial. BMJ. 2010;341:c3337.

    Article  Google Scholar 

  • Cozma AI, Sievenpiper JL, de Souza RJ, et al. Effect of fructose on glycemic control in diabetes: a systematic review and meta-analysis of controlled feeding trials. Diabetes Care. 2012;35:1611–20.

    Article  CAS  Google Scholar 

  • De Natale C, Annuzzi G, Bozzetto L, Mazzarella R, Costabile G, Ciano O, Riccardi G, Rivellese AA. Effects of a plant-based high-carbohydrate/high-fiber diet versus high-monounsaturated fat/low-carbohydrate diet on postprandial lipids in type 2 diabetic patients. Diabetes Care. 2009;32(12):2168–73.

    Article  Google Scholar 

  • Dehghan M, Mente A, Teo KK, et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation. 2012;126:2705–12.

    Article  CAS  Google Scholar 

  • Dyson PA, Kelly T, Deakin T, Duncan A, Frost G, Harrison Z, Khatri D, Kunka D, McArdle P, Mellor D, Oliver L, Worth J, Diabetes UK Nutrition Working Group. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2011;28(11):1282–8.

    Article  CAS  Google Scholar 

  • Eriksson KF, Lindgärde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmö feasibility study. Diabetologia. 1991;34(12):891–8.

    Article  CAS  Google Scholar 

  • Estruch R, Ros E, Salas-Salvadó J, PREDIMED Study Investigators, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.

    Article  CAS  Google Scholar 

  • Evert AB, Boucher JL, et al. Nutrition therapy recommendations for the Management of adults with diabetes: position statement by the ADA. Diabetes Care. 2013;36:3821–42.

    Article  CAS  Google Scholar 

  • Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288(14):1723–7.

    Article  Google Scholar 

  • Forouhi NG, Imamura F, Sharp SJ, et al. Association of plasma phospholipid n-3 and n-6 polyunsaturated fatty acids with type 2 diabetes: the EPIC-InterAct Case-Cohort Study. PLoS Med. 2016;13:e1002094.

    Article  Google Scholar 

  • Franz MJ, Powers MA, Leontos C, et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc. 2010;110:1852–89.

    Article  Google Scholar 

  • Giacco R, Costabile G, Della Pepa G, et al. A whole-grain cereal-based diet lowers postprandial plasma insulin and triglyceride levels in individuals with metabolic syndrome. Nutr Metab Cardiovasc Dis. 2014;24(8):837–44.

    Article  CAS  Google Scholar 

  • Goff LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2013;23(1):1–10.

    Article  CAS  Google Scholar 

  • Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord. 1992;16:397–415.

    CAS  PubMed  Google Scholar 

  • Hu FB, Rimm EB, Stampfer MJ, et al. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr. 2000;72:912–21.

    Article  CAS  Google Scholar 

  • InterAct Consortium, Romaguera D, Guevara M, et al. Mediterranean diet and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study: the InterAct project. Diabetes Care. 2011;34:1913–8.

    Article  Google Scholar 

  • Jenkins DJ, Wolever TM, Taylor RH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34:362–6.

    Article  CAS  Google Scholar 

  • Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  CAS  Google Scholar 

  • Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract. 2005;67(2):152–62.

    Article  Google Scholar 

  • Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes. 1999;48:937–42.

    Article  CAS  Google Scholar 

  • Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383:1999–2007.

    Article  CAS  Google Scholar 

  • Lindström J, Peltonen M, Eriksson JG, et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia. 2006;49:912–20.

    Article  Google Scholar 

  • Lindström J, Peltonen M, Eriksson JG, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56:284–93.

    Article  Google Scholar 

  • Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the Look AHEAD study. Obesity (Silver Spring). 2014;22:5–13.

    Article  Google Scholar 

  • Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566–75.

    Google Scholar 

  • Mann JI, De Leeuw I, Hermansen K, Diabetes and Nutrition Study Group (DNSG), et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis. 2004;14:373–94.

    Article  CAS  Google Scholar 

  • National Kidney Foundation. KDOQI clinical practice guidelines for diabetes and chronic kidney disease. Am J Kidney Dis. 2012;49(Suppl 2):S1–S179.

    Google Scholar 

  • Nkondjock A, Receveur O. Fish-seafood consumption, obesity, and risk of type 2 diabetes: an ecological study. Diabetes Metab. 2003;29:635–42.

    Article  CAS  Google Scholar 

  • Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Dietary Guidelines for Americans: 2015–2020. 8th ed. Available from https://health.gov/dietaryguidelines/2015/guidelines/.

  • Ooi EM, Ng TW, Watts GF, Barrett PH. Dietary fatty acids and lipoprotein metabolism: new insights and updates. Curr Opin Lipidol. 2013;24(3):192–7.

    Article  CAS  Google Scholar 

  • Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.

    Article  CAS  Google Scholar 

  • Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002;25:608–13.

    Article  Google Scholar 

  • Penn L, White M, Lindström J, et al. Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT. PLoS One. 2013;8:e57143.

    Article  CAS  Google Scholar 

  • Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V, Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–97.

    Article  CAS  Google Scholar 

  • Riccardi G, Giacco R, Rivellese AA. Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr. 2004;23(4):447–56. Review.

    Article  CAS  Google Scholar 

  • Riccardi G, Rivellese AA, Giacco R. Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008;87(1):269S–74S.

    Article  CAS  Google Scholar 

  • Rinaldi S, Campbell EE, Fournier J, O’Connor C, Madill J. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes. 2016;40:471–7.

    Article  Google Scholar 

  • Ros E. Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes. Am J Clin Nutr. 2003;78(Suppl):617S–25S.

    Article  CAS  Google Scholar 

  • Salas-Salvadó J, Bulló M, Babio N, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34:14–9.

    Article  Google Scholar 

  • Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Effects of dietary approaches to stop hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition. 2013;29:611–8.

    Article  Google Scholar 

  • Schoenaker DA, Toeller M, Chaturvedi N, et al. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia. 2012;55:2132–41.

    Article  CAS  Google Scholar 

  • Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013;5(4):1417–35. https://doi.org/10.3390/nu5041417. Review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189–96.

    Article  CAS  Google Scholar 

  • The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54.

    Article  Google Scholar 

  • The Task Force on diabetes, pre-diabetes, and cardiovascular diseases. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035.

    Article  Google Scholar 

  • Thomas DE, Elliott EJ. The use of low-glycaemic index diets in diabetes control. Br J Nutr. 2010;104(6):797–802.

    Article  CAS  Google Scholar 

  • Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.

    Article  CAS  Google Scholar 

  • UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.

    Article  Google Scholar 

  • UK Prospective Diabetes Study 7. UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients, UKPDS Group. Metabolism. 1990;39:905–12.

    Article  Google Scholar 

  • Vessby B, Uusitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, Nälsén C, Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB, Storlien LH, KANWU Study. Diabetologia. 2001;44(3):312–9.

    Article  CAS  Google Scholar 

  • vonRuesten A, Feller S, Bergmann MM, Boeing H. Diet and risk of chronic diseases: results from the first 8 years of follow-up in the EPIC-Potsdam study. Eur J Clin Nutr. 2013;67:412–9.

    Article  CAS  Google Scholar 

  • Wang Q, Xia W, Zhao Z, Zhang H. Effects comparison between low glycemic index diets and high glycemic index diets on HbA1c and fructosamine for patients with diabetes: a systematic review and meta-analysis. Prim Care Diabetes. 2015;9(5):362–9. https://doi.org/10.1016/j.pcd.2014.10.008. Epub 2014 Dec 16.

    Article  PubMed  Google Scholar 

  • Wang DD, Li Y, Chiuve SE, et al. Association of specific dietary fats with total and causespecific mortality. JAMA Intern Med. 2016;176:1134–45.

    Article  Google Scholar 

  • Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care. 2000;23(10):1499–504.

    Article  CAS  Google Scholar 

  • Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(Suppl 1):222S–5S.

    Article  CAS  Google Scholar 

  • Wing RR, Bolin P, Brancati FL, et al. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Gabriele Riccardi & Marilena Vitale

  2. Institute of Food Science of National Research Council, Avellino, Italy

    Rosalba Giacco

Authors
  1. Gabriele Riccardi
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  2. Marilena Vitale
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  3. Rosalba Giacco
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Corresponding author

Correspondence to Gabriele Riccardi .

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy

    Enzo Bonora

  2. Diabetes Division, Diabetes Research Unit, University of Texas Health Science Center, San Antonio, TX, USA

    Ralph A. DeFronzo

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Riccardi, G., Vitale, M., Giacco, R. (2018). Treatment of Diabetes with Lifestyle Changes: Diet. In: Bonora, E., DeFronzo, R. (eds) Diabetes Epidemiology, Genetics, Pathogenesis, Diagnosis, Prevention, and Treatment . Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-45015-5_18

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  • DOI: https://doi.org/10.1007/978-3-319-45015-5_18

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