Nutritional intervention

Abstract

Nutritional medical therapy is highly effective and beneficial for people with type 2 diabetes mellitus (T2DM). It is associated with a reduction of up to 2% in HbA1c. The goals of this treatment are to achieve and maintain a healthy weight, reach previously agreed-upon glycemic and lipid targets, and prevent or slow the progression of chronic cardiorenal complications.

It is important to avoid emphasizing macronutrients (carbohydrates, proteins, and fats) and focus nutritional education on foods and dietary patterns. For example, carbohydrates can be very healthy and recommended when we talk about vegetables, fruits, legumes, and whole grains, and strongly discouraged when we talk about sugars, refined grains, and their flours. Dietary patterns arise from the idea that a single eating style is not suitable for everyone; therefore, plant-based diets, the Mediterranean pattern, the DASH diet, low-fat diets, and modified low-carbohydrate diets are appropriate according to each individual's tastes and habits. Nutritional counseling must also consider the patient's various comorbidities, such as dyslipidemia, hypertension, cardiovascular disease, or kidney disease, to prevent the onset or manage associated conditions.

It is advisable to create a meal plan and provide guidance on shopping lists and recipes. Guidance on meal preparation is also essential.

The type of exercise the patient performs (walking, running, strength training), its duration, and intensity should be considered to better guide their baseline diet and any necessary supplementation. Protein intake will vary between 0.8 and 1.5 g/kg of ideal body weight, depending on several patient characteristics, especially the type of exercise performed and the presence or absence of cardiorenal complications. Increasing evidence suggests that a higher intake of plant-based protein and the substitution of animal protein with plant-based protein are associated with a lower risk of all-cause and cardiovascular mortality.

At a time when many patients are using GLP-1 analogues to treat their obesity/type 2 diabetes, nutritional counseling is crucial to avoid the gastrointestinal side effects of these drugs, to enhance their glycemic and fat-loss benefits, especially visceral fat, and to minimize muscle mass depletion.