Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for 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, 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 are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Kaleidoscope model of diabetes care: time for a rethink?

National Audit Data highlight persistent sub-optimum control among increasing numbers of people living with diabetes, with severe consequences for the individual and the NHS. The aim of the present review was to introduce a new cohesive, holistic model of care, tailored to individual needs to support optimum diabetes outcomes. This model of diabetes is necessary in order to understand the driving forces behind behaviour and their impact on diabetes management. Feelings (an emotional state or reaction) and beliefs (an acceptance that something is true or real) are fundamental behavioural drivers and influence diabetes self-management choices. Individually, these explain some of the complexities of behaviour and, collectively, they impact on personal motivation (rationale/desire to act) to achieve a specific outcome. Inevitably, they independently affect diabetes self-management and the environment in which individuals live. A model of care that proposes the encompassing of environment, intrinsic thought and therapy regimens to provide tailored, personalized healthcare should support enhanced diabetes self-management and outcomes from diagnosis. The Kaleidoscope model of care could be deliverable in routine care, incorporating each of the influences on diabetes self-management, and should benefit both individuals with diabetes and healthcare professionals.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.

This article summarizes the Diabetes UK evidence-based guidelines for the prevention of Type 2 diabetes and nutritional management of diabetes. It describes the development of the recommendations and highlights the key changes from previous guidelines. The nutrition guidelines include a series of recommendations for the prevention of Type 2 diabetes, nutritional management of Type 1 and Type 2 diabetes, weight management, management of microvascular and macrovascular disease, hypoglycaemia management, and additional considerations such as nutrition support, end-of-life care, disorders of the pancreas, care of the older person with diabetes, nutrition provided by external agencies and fasting. The evidence-based recommendations were graded using the Scottish Intercollegiate Guidelines Network methodology and, in a small number of topic areas, where strong evidence was lacking, the recommendations were reached by consensus. The Diabetes UK 2011 guidelines place an emphasis on carbohydrate management and a more flexible approach to weight loss, unlike previous guidelines which were expressed in terms of recommendations for individual nutrient intakes. Additionally, the guidelines for alcohol have been aligned to national recommendations. The full evidence-based nutrition guidelines for the prevention and management of diabetes are available from: http://www.diabetes.org.uk/nutrition-guidelines.

The therapeutics of lifestyle management on obesity.

The global incidence and prevalence of obesity continue to increase, with the fastest rate of increase in the developing world. Obesity is associated with many chronic diseases including type 2 diabetes, cardiovascular disease and some cancers. Weight loss can reduce the risk of developing these diseases and can be achieved by means of surgery, pharmacotherapy and lifestyle interventions. Lifestyle interventions for prevention and treatment of obesity include diet, exercise and psychological interventions. All lifestyle interventions have a modest but significant effect on weight loss, but there is little evidence to indicate that any one intervention is more effective. There is evidence of an additive effect for adjunct therapy, and the combination of diet, exercise and behavioural interventions appears to be most effective for both the prevention and treatment of obesity.

An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes.

BACKGROUND: Education plays a key role in the development of self-management skills for people with type 2 diabetes, although there is limited evidence for the use of video education. AIMS: To develop a video-based lifestyle education programme for people newly diagnosed with type 2 diabetes and to evaluate changes in knowledge, biomedical indices and quality of life. METHODS: Forty-two newly diagnosed type 2 diabetic subjects were recruited and randomly allocated to either a video education or control group. Data were collected at baseline and 6 months after the intervention. Subjects (43% male) had a mean (SD) age of 60.8 (9.6) years, weight 89.5 (15.5) kg, BMI 31.3 (5.1) kg m(2), glycated haemoglobin (A1c) 7.4 (1.7)%, total cholesterol 4.7 (1.2) mmol L(-1), high-density lipoprotein cholesterol 1.15 (0.34) mmol L(-1), triglycerides 1.8 (1.0) mmol L(-1), low-density lipoprotein cholesterol 2.8 (1.0) mmol L(-1), pedometer reading 5721 (3446) steps per day. There were 63.7% correct answers given to the ADKnowl questionnaire and the WHO-5 Well-Being score was 65.8%. RESULTS: At 6 months, the intervention group showed increased knowledge compared to controls (74.3% versus 56.4% correct answers, P < or = 0.0001). Although there were no significant differences in changes over 6 months between the two groups, the intervention group showed improvements in A1c (-0.7%, P = 0.024), total cholesterol (-0.5 mmol L(-1), P = 0.017), low-density lipoprotein cholesterol (-0.5, P = 0.018) and increased physical activity measured by pedometer (1266 steps per day, P = 0.043) from baseline, with no significant changes in the control group. CONCLUSIONS: A brief video intervention increased diabetes knowledge amongst those newly diagnosed with type 2 diabetes and may comprise an effective way of directing education to such individuals.

A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes.

BACKGROUND: Recent evidence from randomized controlled trials of hypocaloric low carbohydrate diets in people without diabetes has shown that they promote significant weight loss over the short term. There is very little evidence for any effects of reduced carbohydrate intakes on body weight, glycaemia and cardiovascular risk in people with type 2 diabetes. METHODS: An electronic search was performed using MEDLINE (1966 to March 2007), EMBASE (1988 to March 2007) and Cochrane Central Register of Controlled Trials (1991 to March 2007) using the keywords low carbohydrate, type 2 diabetes and weight loss. Studies including subjects with type 2 diabetes who adopted a reduced carbohydrate weight loss diet were identified. Data were extracted on study design, weight loss, effects on glycaemia and cardiovascular risk and potential adverse effects. RESULTS: Six studies investigating the effects of hypocaloric reduced carbohydrate diets in people with type 2 diabetes were identified. The studies were heterogenous and most included small numbers, were short-term and provided varying amounts of carbohydrate. No studies were identified that were both low carbohydrate (<50 g day(-1)) and also designed as randomized controlled trials. All studies reported reductions in both body weight and glycated haemoglobin, with no deleterious effects on cardiovascular risk, renal function or nutritional intake. CONCLUSIONS: Conclusions are limited by study design and small numbers, but it appears that reduced carbohydrate diets are safe and effective over the short term for people with type 2 diabetes.

A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects.

BACKGROUND: Low-carbohydrate diets are effective for weight reduction in people without diabetes, but there is limited evidence for people with Type 2 diabetes. Aims To assess the impact of a low-carbohydrate diet on body weight, glycated haemoglobin (HbA(1c)), ketone and lipid levels in diabetic and non-diabetic subjects. METHODS: Thirteen Type 2 diabetic subjects (on diet or metformin) and 13 non-diabetic subjects were randomly allocated to either a low-carbohydrate diet (< or = 40 g carbohydrate/day) or a healthy-eating diet following Diabetes UK nutritional recommendations and were seen monthly for 3 months. Subjects (25% male) were (mean +/- sd) age 52 +/- 9 years, weight 96.3 +/- 16.6 kg, body mass index 35.1 kg/m(2), HbA(1c) 6.6 +/- 1.1%, total cholesterol 5.1 +/- 1.1 mmol/l, high-density lipoprotein cholesterol 1.3 +/- 0.4 mmol/l, low-density lipoprotein cholesterol 3.1 +/- 0.9 mmol/l, triglycerides (geometric mean) 1.55 (1.10, 2.35) mmol/l and ketones range 0.0-0.2 mmol/l. RESULTS: Analysis was by intention to treat with last observation carried forward. Twenty-two of the participants (85%) completed the study. Weight loss was greater (6.9 vs. 2.1 kg, P = 0.003) in the low-carbohydrate group, with no difference in changes in HbA(1c), ketone or lipid levels. CONCLUSIONS: The diet was equally effective in those with and without diabetes.

The Fasting Hyperglycaemia Study: II. Randomized controlled trial of reinforced healthy-living advice in subjects with increased but not diabetic fasting plasma glucose.

Self-referred subjects (N = 227) thought to be at risk of developing non-insulin-dependent diabetes mellitus (NIDDM) and with fasting plasma glucose (FPG) in the range of 5.5 to 7.7 mmol.L-1 on two consecutive tests 2 weeks apart were randomized to reinforced or basic healthy-living advice. They were simultaneously allocated either to a sulfonylurea group or a control group in a two-by-two factorial design. A total of 201 subjects in three English and two French centers completed 1 year's follow-up study. Reinforced advice recommending dietary modification and increased exercise was given every 3 months, and basic advice was given once at the initial visit. Glycemia was monitored by FPG, dietary compliance by body weight and food diaries, and fitness compliance by bicycle ergometer assessment and exercise diaries. Both reinforced and basic advice groups had a significant mean reduction in body weight (1.5 kg) at 3 months, although the weight subsequently returned to baseline. After 1 year, subjects allocated to reinforced advice versus basic advice (1) reported a lower fat intake (34.1% v 35.8%, P = .04) with no difference in lipid profiles, (2) had improved fitness as shown by increased calculated maximal oxygen uptake ([Vo2max] 2.39 v 2.18 L.min-1, P = .007) with no change in insulin sensitivity, (3) showed no change in FPG, glucose tolerance, or hemoglobin A1c (HbA1c), and (4) showed a greater tendency to withdraw from the study (16% v 7%, P = .03). In conclusion, reinforced healthy-living advice given to self-referred subjects with increased FPG did not encourage sufficiently pronounced life-style changes for significantly greater effects on body weight and glycemia in a 1-year study than basic healthy-living advice.

Family food purchases and home food consumption: comparison of nutrient contents.

Estimates of nutrient intakes based on food purchasing records modelled on the National Food Survey (NFS) were compared with nutrient intakes calculated from food consumption records based on a semi-weighted method, a combination of weighing and household measurement techniques. Of eighty-two families in Cambridge who completed the study, thirty-two were volunteers and fifty were from a random sample in which the co-operation rate was 73%. The estimated energy and nutrient contents of the Cambridge food purchases were very similar to those reported by the NFS for families of similar composition and income. The energy intakes obtained by the semi-weighed method were compared with results from twenty-five studies of energy intake based on quantitative measurements of food consumption: there was no evidence to suggest that the semi-weighed method consistently under- or overestimated intakes in the Cambridge subjects. Purchases adjusted to allow for waste and consumption of food by visitors contained significantly more energy, protein, carbohydrate, calcium, iron and dietary fibre than measured home food consumption. There was no significant difference in the nutrient content of purchases and consumption per 4.184 MJ (1000 kcal), with the exception of Fe and ascorbic acid. Measured wastage of edible food in thirty-one families averaged 3.2% of purchases. Estimate of wastage in all eighty-two families was 3.8%, and consumption of food by visitors accounted for 3.0% of purchases. The excess of purchases over measured home food energy intake is probably accounted for by a net increase in larder stocks rather than wastage, consumption of food by visitors, or under-recording of intakes.