Evolving Nutritional Therapy for Diabetes Mellitus

Uusitupa, Matti; Schwab, Ursula

doi:10.3390/nu12020423

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…[75][76][77] Very-low-carbohydrate diets are typically high in red and processed meats, which are consistently associated with increased morbidity and mortality, and, for many individuals, are not sustainable. 78,79 In terms of dietary interventions for initial vs long-term remission, very-lowcalorie diets, or liquid meal replacements are only appropriate for achieving initial remission, while more energy-balanced, whole-food diets may be suitable for both initial and sustained remission. 8 The expert panel agreed that the intensity and pace of medication de-escalation (deprescribing) depends on the intensity of the lifestyle intervention.…”

Section: Diet and Remission Of T2dmentioning

confidence: 99%

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Rosenfeld

Kelly

Agarwal

et al. 2022

American Journal of Lifestyle Medicine

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Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.

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Section: Diet and Remission Of T2dmentioning

confidence: 99%

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Rosenfeld

Kelly

Agarwal

et al. 2022

American Journal of Lifestyle Medicine

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“…Conversely, the American Diabetes Association (ADA) annual guidelines continue to recommend a breadth of dairy products as part of a healthy diet, including milk and yogurt, for those with T2D ( 171 ), with no specific promotion of low-fat dairy. The European Society for Cardiology (ESC) guidelines ( 172 ) and the European Association for the Study of Diabetes (EASD) diabetes and nutrition study group (DNSG) ( 173 ) guidelines, expected to be updated in 2020 ( 177 ), both provide umbrella recommendations for SFAs to provide <10 en% and for low trans -fats. Alongside other healthy eating recommendations of consuming a diet high in vegetables, legumes, fruits and wholegrain cereals, EASD makes with no specific reference to dairy, whilst ESC recommends components of the Mediterranean Diet with minimal dairy for CVD prevention, and low-fat dairy for treatment of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Cow's Milk and Dairy Consumption: Is There Now Consensus for Cardiometabolic Health?

Poppitt

2020

Front. Nutr.

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Cow's milk and dairy products derived from this complex food source have long been proposed as beneficial to human health, yet underlying clinical evidence of direct benefit continues to raise controversy. Limited evidence supports positive cardiometabolic effects of a number of dairy macro- and micronutrient components including whey protein and casein, unsaturated fats, milk fat globule membrane (MFGM) and polar phospholipids, vitamin D and calcium, in addition to non-bovine components including bacterial and yeast probiotics. More controversial remain lipid components trans fats, including trans vaccenic acid, trans palmitoleic acid, and conjugated cis trans linoleic acid (CLA), plus medium-chain and odd-chain dairy fats. New evidence is rapidly identifying multiple pathways by which these dairy nutrients may effect health. Processing, including fermentation and homogenization, may also have positive effects. Conversely, the high saturated fat content of dairy has long raised concern, aligned with international guidelines to minimize dietary intake of animal-origin saturated fatty acids (SFA) to achieve better cardiometabolic health. However, led in part by observational studies and meta-analyses showing dairy to have no or even an inverse association with cardiometabolic health, evidence from randomized controlled trials (RCTs) has been scrutinized over the last 5 years, and focus on low-fat dairy has been challenged. Recent evidence supports the hypothesis that adverse effects of SFAs on metabolic health may be ameliorated when these fats are consumed within a complex matrix such as milk, cheese or yogurt, and that dairy food categories may influence outcomes as much as total fat content. For example, yogurt and high-fat, high-SFA cheese have a negative association with risk of type 2 diabetes (T2D) in many, not all, published trials. However, large sample dairy RCTs of long duration with CVD or T2D incidence as primary endpoints are lacking. This is a clear research gap, with these clinical studies required if a causative link between dairy and improved cardiometabolic health is to be confirmed and in turn promoted through dietary guidelines. Current advisories from national guidance groups such as American Heart Association (AHA) and European Society of Cardiology (ESC) continue to promote consumption of low-fat dairy products, whilst liquid milk and yogurt remain part of nutrition guidelines from joint American Diabetes Association (ADA)/European Association for Study of Diabetes (EASD) reports, and as part of a “no-one-size-fits-all” answer to diet and T2D by the ADA in their most recent 2019 Consensus Report.

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“…There is a strong correlation between vaccination intentions and perceived safety, according to one study [99]. There is another study that concludes religious beliefs may reduce the intention to get the COVID-19 vaccine [100] A study conducted in the UK found that distrust of the vaccine and fear of adverse effects in the future played a major role in achieving mass immunity against COVID-19, where unwillingness to get vaccinated was common among the general population [101].…”

Section: Lifestyle Modifications For Both Covid-19 and Diabetesmentioning

confidence: 99%

relationship between diabetes mellitus, psychological stressors and COVID-19 challenges and managements

Khalil

Elgamal

Naser

2022

ijhs

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Background: COVID-19 outbreak is likely to cause psychological problems, such as anxiety, depression, and stress; which may negatively influence one's glycemic control. The pandemic could increase the prevalence and change in nature of diabetes among people living in countries affected by it. The aim of this review is to clarify the blurred areas and types of relationship between diabetes, psychiatric disorders, and COVID-19 pandemic. Methods: Literature reviews and evidence-based researches were studied using PubMed and Google Scholar for the following keywords: "COVID-19", "SARS-CoV-2", "diabetes", "epidemiology", "pathophysiology", "ACE2", "manifestation”, “immune system”, “link between diabetes and psychiatric illnesses”, and "treatment with antipsychotics and antidepressants”. Results revealed that there is a casual mutual relationship between DM and psychiatric disorders. Furthermore, there is a bidirectional relationship between DM and the vulnerability of acquiring COVID-19 infection. Additionally, DM and SARS-CoV-2 infection worsen each other, thus, diabetics are more likely to develop severe COVID-19. Conclusion and Recommendation: It is recommended that physicians and health care providers counsel their patients that the risk of DM can be significantly reduced by lifestyle changes including diet and exercise. Additionally, a range of psychological interventions, and mandatory vaccinations against COVID- 19 when dealing with diabetic patients.

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Evolving Nutritional Therapy for Diabetes Mellitus

Abstract: One of the special issues in Nutrients in 2020 focuses on the nutritional therapy for diabetes mellitus [...]

Cited by 7 publications

References 19 publications

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine

Cow's Milk and Dairy Consumption: Is There Now Consensus for Cardiometabolic Health?

relationship between diabetes mellitus, psychological stressors and COVID-19 challenges and managements

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