Essential Dietary Tips for Diabetes Prevention and Management - Internal Medicine

Dr. He Niaotong reply Internal Medicine

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Dear Lee,
Primary prevention of diabetes starts from the community-based healthcare system, providing necessary regular screenings for high-risk groups (as shown in Table 1-1).
The goal of primary prevention is to implement preventive interventions for populations with a high susceptibility to diabetes in order to prevent its onset.
Secondary prevention focuses on early diagnosis of diabetes and active, effective treatment to achieve optimal control, aiming to avoid or reduce the progression of the disease.
Tertiary prevention aims to prevent the occurrence and continued deterioration of late-stage complications of diabetes.
Table 1-1 Major Risk Factors for Type 2 Diabetes:
- Family history of diabetes (parents, siblings with diabetes)
- Age over 45 years
- Overweight (Body Mass Index ≥ 24 kg/m²)
- Lack of regular physical activity
- Ethnicity/race (e.g., South Asian, Caribbean African, etc.)
- History of abnormal fasting glucose or impaired glucose tolerance
- Hypertension (adults ≥ 140/90 mmHg)
- High-density lipoprotein cholesterol ≤ 35 mg/dL (0.90 mmol/L) and/or triglycerides ≥ 250 mg/dL (2.82 mmol/L)
- History of gestational diabetes or infants weighing over 4.0 kg
- History of cardiovascular disease
- Polycystic ovary syndrome
(I) Carbohydrates and Diabetes
A.
Carbohydrates and monounsaturated fatty acids should account for 60-70% of total caloric intake.
The metabolic control status of patients and the need for weight loss can be considered when determining the amount of monounsaturated fatty acids in the diet.
B.
A healthy diet should include sucrose and foods containing sucrose, but the composition of other nutrients, such as fats, should also be considered.
(II) Proteins and Diabetes
A.
For diabetic patients with normal kidney function, there is no need to adjust their usual protein intake (15-20% of total calories).
B.
Although short-term consumption of a high-protein, low-carbohydrate diet can reduce weight and improve blood glucose, it remains uncertain whether this diet is suitable for long-term consumption by diabetic patients and its long-term effects on weight loss and blood glucose control.
(III) Dietary Fatty Acids and Diabetes
1.
Saturated Fatty Acids and Cholesterol in the Diet
(1) Diabetic patients should primarily control their intake of saturated fatty acids and cholesterol.
Low-density lipoprotein is mainly affected by saturated fatty acids, and diabetic patients appear to be more sensitive to cholesterol than non-diabetic individuals.
The total fat and saturated fatty acid content in the diet is positively correlated with total cholesterol and low-density lipoprotein levels in the blood.
(2) Incorporating exercise can further reduce total cholesterol, low-density lipoprotein, and triglycerides in the blood, and can prevent the decrease in high-density lipoprotein caused by a low-fat diet.
(3) High monounsaturated fatty acids improve postprandial blood glucose and triglycerides but do not show the same effects on fasting blood glucose or glycated hemoglobin.
It is important to note that a high monounsaturated fatty acid diet, if not calorie-controlled, may lead to weight gain.
Therefore, the decision to replace saturated fatty acids with carbohydrates or monounsaturated fatty acids should be based on the patient's metabolic control status, need for weight loss, and cultural background.
(4) N-3 polyunsaturated fatty acids can lower triglycerides in patients with type 2 diabetes, although they may be associated with an increase in low-density lipoprotein, there are no adverse effects on blood glucose; N-3 polyunsaturated fatty acids are helpful in treating severe hypertriglyceridemia.
For healthy individuals, consuming N-3 polyunsaturated fatty acids has cardioprotective effects, and it is recommended to eat 2-3 servings of deep-sea fish per week.
(5) Trans-unsaturated fatty acids, derived from the hydrogenation of vegetable oils to solidify them, have effects on low-density lipoprotein similar to those of saturated fatty acids and lower high-density lipoprotein; therefore, intake of trans-unsaturated fatty acids should be limited.
(6) Plant sterols and plant sterol esters can inhibit the absorption of cholesterol from the diet and bile.
Consuming 2 grams of plant sterols and plant sterol esters daily can lower total cholesterol and low-density lipoprotein.
2.
Low-Fat Diet
A low-fat diet can moderately reduce weight, lower total cholesterol and triglycerides, and increase high-density lipoprotein.
In the long term, it can moderately reduce weight without showing an increase in blood triglyceride levels.
3.
Fat Replacers
Reducing fat intake can be achieved by decreasing the portion sizes of high-fat foods, providing low-fat or fat-free foods and beverages, or using fat replacers (which mimic the properties of fat but have significantly lower calories).
The U.S.
Food and Drug Administration has recently approved certain fat replacers for safe use in foods; regular use of fat replacers can reduce dietary fat intake, but may not necessarily lower caloric intake or body weight.
(IV) Vitamins and Minerals
It is recommended that elderly individuals, pregnant women, breastfeeding mothers, strict vegetarians, and those on calorie-restricted diets take a multivitamin supplement.

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Reply Date: 2004/11/09