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Diet for Diabetics

Updated 20 October 2021

Subject Biology ,  Medicine

Downloads 48

Category Food ,  Health ,  Science

Topic Body ,  Human ,  Nutrition ,  Rice

Importance of Nutrition in Human Health

One of the most important aspects of human health is food and nutrition. Food plays an important role in the body's immunity and infection resistance. The nurse must ensure that the patients' lives are maintained, which includes not only the use of synthetic medicine but also proper nutrition. In other cases, nurses and physicians may be required to provide nutritional support in order to save the patient's life. Even if a specific diet or nutrition is not part of the doctor's prescription to the nurse, nutrition assistance should be provided in the patient's best interests (Ley, Hamdy, Mohan & Hu, 2014).

Considerations for Nutritional Support in Diabetic Patients

However, for nutritional support for a diabetic patient to be justifiable, it would be essential to consider the current dietary needs of the patients and the extent to which they are being met through regular diet. It would also be crucial to find the length of time the patient has been on an inadequate diet. Once the nurse has accessed the past nutritional status of the patient, it would be important to obtain the patient's current nutritional state as well as their medical conditions. Obviously, for a diabetic patient, food with low calories and sugar would help them not only in recuperating but also improving their medical status (Evert, Boucher, Cypress, Dunbar, Franz, Mayer, & Yancy, 2014). Nutritional support would be applied just through modified food menus. All the patient needs is food with low calories, thus it would be important that they eat fruits and whole grains.

Dietary Recommendations for Diabetic Patients

When dealing with a diabetic patient, it would be important to limit food with high sugar and eat smaller portions of food evenly throughout the day. It would also be critical to eat less carbohydrates, salt, and fat. The body system of a person ailing from diabetes cannot make a good use of insulin; which leads to high blood sugar levels. Eating food with less sugar level and other food such as fruit and vegetables help the body to keep the sugar in check. This not only helps the body to regulate the amount of blood sugar intake but also helps to reduce the level of sugar in the blood thus hastening healing.

Importance of Diabetic Diet to Different Cultural Backgrounds

Prescribed diet is in the best interest of the patient. It would be important that a patient with diabetes or pre-diabetes develops a healthy eating plan that would help keep the sugar level in control and manage body weight to keep such medical conditions as heart diseases at bay. Diabetic menus help to reduce high blood pressure and cholesterol levels. When an individual intakes excess calories, sugar level often goes off the charts, which could lead to other health problems such as kidney failure and heart damage (Evert, Boucher, Cypress, Dunbar, Franz, Mayer, & Yancy, 2014). However, diabetic menus are smart and safe choices for type 1 and type 2 diabetic patients. The menus could even help in hastening weight loss while giving the patient a host of other health benefits (Ley, Hamdy, Mohan & Hu, 2014).

Research on the Health Benefits of a Diabetic Diet

Research done by Ley, Hamdy, Mohan & Hu (2014) indicates that eating diabetic meals not only by patients ailing from this condition but also the healthy individuals could help keep them healthy. Health benefits inherent in this diet are: keeps the sugar level, blood pressure, and cholesterol levels in check. Diabetic diets also in control of the body weight. It reduces diabetes and keeps it at bay; definitely, this menu contributes to general well-being.

Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 037(Supplement 1), S120-S143.

Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 0383(9933), 1999-2007.

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Diabetic Diet and Food Restrictions Dissertation


Diabetes is a disease caused by the inability of the body to control blood sugar because of the lack or inadequate production of insulin by the B cells of the pancreas.

Types of Diabetes

There are two types of diabetes namely diabetes type1 and type II. From a medical point of view, it is evident that diabetes type 11 is the most prevalent or common form of diabetes among diabetic people.

Type 1 Diabetes

Type 1 has early onset and therefore affects children but in some cases, it attacks any age. Type 1 is autoimmune. It occurs due to the inability of the pancreas to produce insulin as a result of the destruction of beta-cells by the immune system.

Type 2 Diabetes

It occurs when the human body does not generate adequate insulin or if the body fails to utilize the generated insulin properly. Adult people are the most prone to type 2 diabetes which hampers the pancreas from performing its function as required. Among the adults, it is common for obese people aged above 40 years old particularly for those whose has a history of the same (Lewis, Dirksen, Heitkemper, Bucher, 2010).

Various indications for a diabetic diet

A diabetic diet comprises meals that are aimed at reducing the elevated blood sugar levels in diabetic people. A diabetic diet can be considered a healthier meal for diabetic people. A diabetic diet is indicated for people with elevated blood sugar and diagnosed as prediabetics. This aids in averting the progression of the condition to chronic disease or full-blown diabetes. Some of the symptoms that lead to the initiation of the diet by the physicians and nutritionists include Unquenchable thirst that may lead to increased consumption of water. Another symptom of a diabetic diet includes weakness and fatigue because the pancreas fails to release insulin that helps glucose to move into the body cells to produce energy (Ezrin & Kowalski, 1999). The diet is also indicated for those people who are predisposed to developing type 11 diabetes due to their family history. This is precautionary as these people are liable to develop diabetes. It is also indicated in diabetics to prevent the development of complications such as kidney failure, diabetic nephropathy among others. In these circumstances, low-calorie foods with high fiber content are indicated and if foods with high calories are used they should be divided into 6 smaller meals as opposed to the conventional three heavy meals.

Scientific Rationale for a Diabetic Diet

Refers to ways through which diabetic people can reduce or cut down the blood sugar levels in their bodies to normal levels. The principle behind this is that with a proper diet, blood sugar levels can be reduced to the normal range. The most prevalent scientific measure is the use of supplements in people’s meals. Examples of supplements include traditional low-fat meals or diets because they contain few simple carbohydrates and protein (Ezrin, & Kowalski, 1999).

Food/Fluid restriction appropriate for the diet

Diabetic people should take foods that are not rich in simple carbohydrates in order to lower the risks of the disease. Taking of traditional low-fat diet would be of much help to them because it will help in curing the disease hence enabling diabetes people to restore their health. Simple carbohydrates include sugarcanes, and sweet potatoes among others (Rubin, 2011).

Short nutritional teaching plan to a client and family with cultural differences

It would be quite difficult to develop a nutritional teaching plan for people with vast cultural differences but the only important thing is to make the teaching plan neutral to all regardless of the cultural differences. Some people may prefer a modern diet to a traditional diet an action that may trigger the development of diabetes. As a teacher, you must be in apposition to define the level of ingredients contained in the diet. This simply will try to cut down the cultural differences thus advocating health matters or issues to the people (Lewis, Dirksen, Heitkemper, Bucher, 2010).

Application of current research related to a nutrition topic

From the current research modern poor eating habit has been cited as a major factor contributing to diabetes diseases compared to the past. The habit involves a lot of carbohydrates foods being consumed that are richer in sugar as opposed to traditional low fat diets. Modernity has led to ignorance of traditional low-fat diets thus advocating for diets that are artificially made by the people (Ezrin & Kowalski, 1999).

Ezrin, C & Kowalski, R.E. (1999). The Type II diabetes diet book . London: McGraw-Hill Professional.

Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L. (2010). Medical-surgical nursing: Assessment and management of clinical problems. 8 Edn.New York, NY: Elsevier-Health Sciences Division.

Rubin, A.L. (2011). Diabetes for Dummies . Hoboken: Dummies.

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IvyPanda. (2022, March 30). Diabetic Diet and Food Restrictions. https://ivypanda.com/essays/diabetic-diet-and-food-restrictions/

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Diabetic Diet

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Patient handouts, what is diabetes.

If you have diabetes , your blood glucose, or blood sugar , levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes , your body doesn't make insulin. With type 2 diabetes , your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood sugar levels.

Prediabetes means that your blood sugar levels are higher than normal but not high enough to be called diabetes. If you have prediabetes, you are more likely to develop type 2 diabetes.

How do the foods I eat affect my blood sugar levels?

The sugar in your blood comes from certain foods called carbohydrates , or "carbs." Foods that are high in carbs include candy and sweets, sodas, breads, tortillas, and white rice. The more carbs you eat, the higher your blood sugar level will be.

Whether you have type 1 or type 2 diabetes, making the right food choices is an important way to keep your blood sugar at a healthy level. When you control your blood sugar, you lower your chance of having serious health problems from diabetes , such as vision loss and heart problems .

And if you have prediabetes or are at risk for diabetes, eating foods that keep your blood sugar levels healthy may help prevent type 2 diabetes later on.

What's the best diet for diabetes?

There isn't a specific diet or meal plan that works for everybody. Your health care provider may have you see a registered dietician (RD) or a diabetes educator who can help design the best eating plan for you. The plan will consider:

  • Any medicines that you take
  • Your weight
  • Any other health conditions you have
  • Your lifestyle and tastes

All eating plans for diabetes have a few things in common, including eating the right foods in the right amounts at the right times .

What foods should I eat if I have diabetes?

Eating the right foods for diabetes means eating a variety of healthy foods from all the food groups:

  • Fruits and vegetables
  • Whole grains, such as whole wheat, brown rice, barley, quinoa, and oats
  • Proteins , such as lean meats, chicken, turkey, fish, eggs, nuts, beans, lentils, and tofu
  • Nonfat or low-fat dairy, such as milk, yogurt, and cheese

What foods should I limit to control my blood sugar?

To keep your blood sugar under control, you may need to cut back on foods and drinks that are high in carbs. This doesn't mean that you can never enjoy them. But you will need to have them less often or in smaller amounts.

The high-carb foods and drinks you should limit include:

  • Sugary foods, such as candy, cookies, cake, ice cream, sweetened cereals, and canned fruits with added sugar
  • Drinks with added sugars, such as juice, regular soda, and regular sports or energy drinks
  • White rice, tortillas, breads and pasta - especially those made with white flour
  • Starchy vegetables, such as white potatoes, corn, and peas

You may also need to limit how much alcohol you drink, as well as how much fat and salt you eat.

What else do I need to know about diabetic diets?

If you have diabetes, it's important to eat the right amount of food every day. Your eating plan will include how much to eat, so that you get the right amount of carbs in each meal or snack. You'll learn how to count carbs and measure your food.

Eating at the right times is also important. You will want to plan for regular, balanced meals to avoid high or low blood sugar levels. Eating about the same amount of carbs at each meal can be helpful.

Your eating plan will also teach you how to stick with your plan at home and when you eat out.

Eating healthy to control your blood sugar does take some effort. But the reward is a chance to live your healthiest life with diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

  • Diabetes and Nutrition (American Academy of Family Physicians) Also in Spanish
  • How an RDN Can Help with Diabetes (Academy of Nutrition and Dietetics)
  • Living with Diabetes: Eat Well (Centers for Disease Control and Prevention) Also in Spanish
  • Tasty Recipes for People with Diabetes and Their Families (Centers for Disease Control and Prevention) - PDF
  • Carb Counting and Diabetes (American Diabetes Association)
  • Diabetes and Your Diet (American Heart Association)
  • Meal Planning (American Diabetes Association)

From the National Institutes of Health

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  • Diabetes and Cultural Foods (Centers for Disease Control and Prevention) Also in Spanish
  • Fiber: The Carb that Helps You Manage Diabetes (Centers for Disease Control and Prevention) Also in Spanish
  • Healthy Food Choices Made Easy (American Diabetes Association)
  • Non-Starchy Vegetables (American Diabetes Association)
  • Protein (American Diabetes Association)
  • Understanding Carbs (American Diabetes Association)
  • What Superstar Foods Are Good for Diabetes? (American Diabetes Association)
  • MyFoodAdvisor (American Diabetes Association)

Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine)

  • Article: Low-Glycemic Index Diets as an Intervention in Metabolic Diseases: A Systematic...
  • Article: 'Old Is Gold': How Traditional Indian Dietary Practices Can Support Pediatric...
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  • American Diabetes Association
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  • Counting carbohydrates (Medical Encyclopedia) Also in Spanish
  • Diabetes type 2 - meal planning (Medical Encyclopedia) Also in Spanish
  • Glycemic index and diabetes (Medical Encyclopedia) Also in Spanish
  • Snacking when you have diabetes (Medical Encyclopedia) Also in Spanish
  • Sweeteners - sugar substitutes (Medical Encyclopedia) Also in Spanish

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Type 1 Diabetes and Appropriate Therapeutic Diet

Food and nutrient intake and assessment.

In type 1 diabetes therapy, nurses monitor the quantity and quality of food that patients consume in their diet. Health workers also analyze the drinks consumed and the diet in general. To record the results of the assessment, the nurses make entries in the food diary, indicating the quantity, quality, and time of meals. The patient himself can enter the necessary data after the explanations of the doctor or nurse, or ask someone from those who support him. Methods for assessing food and nutrient intake include the Food Frequency Questionnaire.

Calorie Counting Method and Food Group Balance Interpretation

Calories are needed to maintain the energy balance of the diet, in particular the structure and function of the body, health, and well-being, including healing and physical activity. Diet and calorie intake also dictate the need for other nutrients, such as macronutrients, micronutrients, and nutritional supplements. Therefore, the nutritional balance assessment includes an assessment of the quantity and quality of food, based on a diary or 24-hour reviews. Nutritional analysis programs use this information to provide a comprehensive assessment by comparing direct and indirect calorimetry based on the patient’s age, height, weight, and activity level. Quantitative Diet Models include USDA Nutrition Scheme, USDA Vegetarian Food, USDA Mediterranean Cuisine, DASH Diet Scheme, Diabetes Exchange Meal Scheme, and others.

Evaluation and Interpretation of Foods and Beverages

Doctors and nurses evaluate data from questionnaires and diaries using software such as the Healthy Diet Index (HEI), Diet quality index (DQI), Healthy diet index (HDI), and Mediterranean diet index (MDI), evaluating and interpreting beverages such as water, caffeine, and alcohol involves examining their consumption patterns. Studying and evaluating the diet of drinks is important as they account for 75% to 85% of daily water intake, and 14% to 22% of total energy intake.

The assessment considers the risks and consequences associated with such health factors as obesity, bone health, cardiovascular disease, and kidney disease. Health professionals do not recommend the use of alcohol and carbonated drinks, as they are of low nutritional value. Moreover, such drinks are deemed dangerous, due to the adverse health effects of caffeine and alcohol, whereas inadequate drink intake increases risks of obesity and bone health.

Evaluation and Interpretation of Macronutrients

Health care providers evaluate nutritional components such as calories and macronutrients. The most common macronutrients are sugar, soluble fiber, saturated fat, and trans-fatty acids. Information about the calories contained in macronutrients and their qualities is contained in the diagrams and tables of the special software. To monitor macronutrient intakes, nurses and doctors monitor intake to be in line with generally accepted acceptable daily averages. These values are developed following the results of a variety of studies that meet the requests and needs of 97% -98% of people. Recommended Dietary Allowances (RDA) include the required recommended amount of protein and carbohydrates, which, however, is the lower limit of the recommended intake to prevent deficiency. Then, Acceptable Macronutrient Distribution Ranges (AMDRs) are research-defined ranges that minimize the risk of chronic disease by defining recommended percentages of protein, fat, and carbohydrate intake

Evaluation and Interpretation of Micronutrients

Similar to the macronutrient assessment, doctors and nurses assess the micronutrient diet of patients using the software. Various programs provide information on dietary recommendations for various vitamins and minerals found in foods. The information that gets into the charts and tables given by the programs appears as a result of the chemical analysis of products. Trace elements and biologically active components of the diet determine the nutritional value and usefulness of the diet. At the same time, biologically active components interact with components of the body’s living tissue and have many different possible effects.

Food Intake and Nutrition Knowledge

The food intake and knowledge needed can be related to the education and subsequent application of the therapeutic diet. These can be diets designed for past hospitalizations or obtained through a table review. Knowledge, beliefs, and views about nutrition can be obtained from interviews or patient surveys. Noteworthy, the information about knowledge should be identified to determine the level to which the patient the consequences and dangers of inadequate nutrition.

The nurse or physician needs to know the patient’s beliefs as it helps to identify problems in knowledge and to explain important aspects about medicinal and nutritional substances in foods, to provide culinary advice, and to learn about the impact of cultural or religious values ​​on nutrition. Also, during the interview, the health care provider can find out if the patient has problems with emotional overeating, and if he is ready to change his diet.

Eating Behavior and Alternative Medicines

Patient eating behavior includes nutritional activities, including possible problematic practices. For example, obstacles or problems may include refusing to eat, not wanting to try new foods, cleansing the body, or overeating. Eating behavior can be controlled by self-control measures developed in conjunction with the patient. Interestingly, nutritional supplements should be evaluated in terms of their possible interactions with the food and medications the patient is taking.

Therefore, the health care provider should ask the patient about the current medications and supplements they are taking, as well as foods and drinks, since the combination of these elements can change metabolism, nutrient absorption, and gastrointestinal function. Then, the nurse or doctor also evaluates access to food, including the availability of grocery stores and access to safe foods and drinks. Moreover, the nurse should provide access to food to fix the problem of poor nutrition.

Clinical Tests

Today, healthcare providers justify the need for each test by explaining the reasons why it is needed. Typically, medical professionals order this Basic Metabolic Panel (BMP) and Comprehensive Metabolic Panel (CMP). These panels include Medicare and Medicaid Services approved test groups. When prescribing BMP and CMP, the nurse should advise the patient to fast for 10-12 hours before the test. Notably, the CMP consists of six additional tests to assess the liver and all BMP tests. These tests measure glucose, Na +, K +, Cl-, HCO3-, Phosphorous, and Triglycerides.

Chemical Tests in Urine Analysis

Chemical tests in urinalysis are done to look for possible health problems, such as kidney stones or urinary tract infections. For example, a pH of 4.6-8, acidic, is seen in patients on a high-protein diet, while taking medication, in the presence of uric acid kidney stones, calcium oxalate, and cystine. At the same time, alkaline pH <4.6 is observed in patients who eat a diet rich in vegetables and dairy products, but also with urinary tract infections, as well as with certain medications or with phosphate and carbonate kidney stones. Patients with diabetes show non-positive glucose, patients with uncontrolled type 1 diabetes show positive ketones.

Assessment of the State of Hydration

In diabetes, a nurse or doctor assesses your hydration status to determine possible electrolyte imbalances. Dysregulation of water is very dangerous, as it can include a decrease in extracellular fluid, sodium intoxication, dehydration, overhydration, and other symptoms. Dehydration can result from electrolyte loss through vomiting, diarrhea, overuse of laxatives, diuretics, or limited access to fluids. Dehydration can be accompanied by high fever, high sweating, nausea, anorexia, or depression. Symptoms of dehydration include rapid weight loss, decreased skin turgor, dry mucous membranes, weak and fast pulse, slow capillary filling, decreased body temperature (95 ° to 98 ° F), cold extremities, disorientation. Dehydration can lead to volume depletion, that is, a state of vascular instability due to blood loss, burns, vomiting, diarrhea, and gastrointestinal bleeding.


Overhydration or edema may occur in patients with an increase in extracellular fluid volume. Edema can be a sign of kidney failure, liver cirrhosis, chronic heart failure, sodium-containing intravenous fluids, or food. Edema leads to symptoms such as rapid weight gain, dilated neck veins, wheezing in the lungs, peripheral edema, slow peripheral venous emptying, ascites, polyuria, pleural effusion, and pulmonary edema in severe cases. Therefore, health workers measure hydration status in a laboratory way using elements such as blood urea nitrogen, serum osmolality, and urine specific gravity. It is noteworthy that the analysis and interpretation of laboratory results should be as accurate as possible since the diagnosis and subsequent treatment of patients depends on them.

The Nutrition Care Process

The Academy of Nutrition and Dietetics has developed a standardized framework for professional nutrition care and called it the Nutrition Care Process (NCP). This structure has been adopted by nutritionists around the world, which has contributed to the improvement of the model. The NCP includes the steps for identifying, planning, and meeting nutritional needs. This model is applicable to meet the needs of groups or populations, and therefore is convenient for the implementation of various international charitable programs. The model also guides defining nutritional roles and responsibilities for Registered Dietitians-Dietitians (RDN) and Registered Dietitians and Nutritionists (NDTR) in all practice settings.

Nutrition Assessment and Reassessment

Nutritional assessment involves obtaining, validating, and interpreting data to identify health problems. These assessments create the prerequisites for making a nutritional diagnosis and are noted as symptoms or evidence in the nutritional diagnosis statement. Evaluating nutrition through a screening tool helps determine if a patient is at risk based on a summary of aspects of the patient’s life.

Assessment parameters have well-defined terms that should be used by healthcare providers in their assessment. These terms cover five areas, including nutritional history, anthropometric findings, biochemical findings, nutritional physical examination findings, and client history. Equally important, nutritional assessment is based on comparative standards, that is, criteria and norms against which nutritional assessment data are compared.

Nutrition Diagnosis and Intervention

A nutritional diagnosis is made to give a critical assessment of a specific health problem that can be solved with common sense and the right solutions. Also, this problem can be solved by intervention in the diet of a nutritionist. The diagnosis should take into account the causes of problems and provide patients with the tools to improve the situation on their own. Then, intervention should be undertaken to eliminate the signs and symptoms of the health problem.

The nutritional intervention consists of planning and execution stages and is directed at the etiology, i.e. the problem in the field of knowledge related to nutrition. Therefore, an intervention for the etiological problem of a lack of nutritional knowledge is being addressed by nutrition education. If a referral to an etiology is not possible, the nurse resolves the problem by direct intervention to change the diet.

Nutrition Intervention Terminology, Monitoring, and Evaluation

The terminology of nutritional interventions encompasses five areas, namely (1) food delivery, (2) nutrition education, (3) nutritional counseling, (4) specialist nutritional coordination, and (5) interventions on the nutrition of the population. Therefore, interventions can include education, counseling, food delivery. Monitoring and evaluating nutritional therapy implies the need to track indicators in nutrition, for example, indicators of excessive consumption of some micro- or macro-elements. In a clinical setting, interventions are monitored and evaluated to ensure that strategic treatment goals are achieved. In this process, it is very important to write down goals in measurable terms and compare the statuses of indicators and indicators.

Behavior Change and Related Factors

Nutritional behavior change is a collaborative effort between the patient and the nutritionist. Behavior modification is the change in a person’s responses to environmental cues through negative reinforcement of maladaptive behavior and positive reinforcement of adaptive behavior. Both education and counseling help patients achieve behavioral nutritional goals. Several factors influence a person’s ability to change behavior, such as the talent of a nutrition educator or the ability of a counselor. There are different levels of influence, including personal, interpersonal, institutional, social, and political, which are described in the socio-ecological model. Official US guidelines support the use of this model in patients’ diets.

Models for Behavior Change

Health professionals advise people on behavior change and educate them about nutrition using a variety of theories and models. The belief in the health model influences clients’ beliefs that they can get sick from unhealthy diets by explaining negative aspects such as the severity of the disease and positive aspects such as belief in positive effects and reducing risks. They also stimulate self-efficacy so that patients believe they can achieve what they want and give prompts for action. The trans-theoretical model introduces the person to change, and helps him take the first steps, and also ensures its action for 6 months, and offers 6 more months of support. At the same time, the stage of cessation within the framework of the model assumes that a person stops thinking about change, as he acquires a new habit.

Lifestyle and Health Risk Factors

Life expectancy in the United States continues to rise, although growth rates are nearly 4% lower among African Americans, due in part to diseases and deaths from diabetes. Therefore, there is a need to educate the population about healthy eating and take preventive measures. Risk factors in the United States that determine morbidity and mortality are heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease, accidents, Alzheimer’s disease, diabetes, and nephritis. Chronic diseases are the most costly item of expenditure, accounting for 75% of costs. Diet and lifestyle directly affect chronic diseases such as heart disease, stroke, cancer, and diabetes. The influence of social determinants and environmental factors is equally important.

Health and Nutritional Disorders

Health and nutritional disorders are especially evident in the differences in the level of health among members of different races living in the United States. A complex combination of social, environmental, and behavioral factors has contributed to the creation of racial and group inequalities in health. Health inequities are associated with differences in the burden of disease, including in terms of overall morbidity, prevalence, mortality, and survival rates.

Social determinants of health include socioeconomic factors, psychological influences, discrimination, and social support. These determinants affect the behavioral, physical, and built environment and sociocultural areas at all levels. Nutrition can be seen as a major component of health inequalities. For diseases like hypertension, type 2 diabetes, obesity, and kidney disease, nutritional care is essential. Therefore, strategies are needed to address nutritional inequalities, including dietary strategies and health literacy.

Diabetes in the US

Eating carbohydrate foods leads to high blood sugar for most people. However, with diabetes mellitus, there is a long-term increased concentration of glucose in the blood. Hyperglycemia or high glucose levels are caused by impaired insulin secretion or the action of insulin. Insulin is produced by the pancreas for the use and storage of macronutrients such as carbohydrates, fats, and proteins. Diabetes mellitus leads to an increase in mortality and morbidity, which can be reduced through prevention. Prevention will also reduce direct medical and disability costs.

Incidence and Prevalence

In the US, 9.4% of the population has diabetes, which is more than 30 million people, with 7 million undiagnosed. Diabetes diagnoses continue to rise in adults, that is, people 18 years of age and older, and the prevalence of the disease increases with age, as almost 40% of those aged 65 and older have this problem. The prevalence of type 2 diabetes has increased dramatically in younger groups, and younger ethnic minority groups.

Glucose Intolerance Categories

There are different categories of glucose intolerance, and the correct definition of the category can be crucial in the treatment of the disease. Type 1 diabetes mellitus has symptoms of excessive thirst, significant weight loss, and frequent urination. During the development of such diabetes, the beta cells of the pancreas, which produce insulin, are destroyed. This leads to the onset of the listed symptoms, as well as excessive hunger, dehydration, electrolyte disturbance, and ketoacidosis. The rate of beta-cell destruction is highest in infants and children, while it is slower in adults. Therefore, with the destruction of beta cells that begins in adulthood, adults can face a prolonged asymptomatic period of onset of the disease, which can last from several months to several years, until the beta cells are gradually destroyed.

Two Forms of Type 1 Diabetes

Remarkably, 5% of all diabetes cases are type 1 diabetes, and people with type 1 diabetes depend on insulin that is not produced by their bodies. If they don’t take exogenous insulin, they can die from ketoacidosis. Type 1 diabetes mellitus is usually diagnosed in young people and people over 65 years of age. It is noteworthy that symptoms may include weight loss or, conversely, gaining excess weight. There are two forms of type 1 diabetes mellitus – immune-mediated and idiopathic. Immune-mediated diabetes occurs as a result of the destruction of the beta cells of the pancreas, which are responsible for the production of insulin. Idiopathic diabetes mellitus is a disease of unknown etiology; only a small percentage of people fall into this category, but this disease has no known cure. Autoimmune thyroid disease is often associated with type 1 diabetes, so population screening includes a thyroid health check.


People with type 1 diabetes experience destruction of the beta cells of the pancreas. This leads to an increase in blood glucose levels, and the emergence of markers of destruction such as islet cell autoantibodies; autoantibodies to insulin; autoantibodies to glutamic acid decarboxylase, and autoantibodies to tyrosine phosphatases. These autoimmune markers are indicative of type 1 diabetes. Genetically, there is an association between TIDM and the histocompatibility locus (HLA) antigen, with links to the DQA, DQB, and DRB genes. Remarkably, adults can maintain sufficient b-cell function for a long time to prevent DKA.

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Example Of Essay On Diabetes And The Effects Of Nutrition And Lifestyle

Type of paper: Essay

Topic: Lifestyle , Diabetes , Health , Blood , Medicine , Risk , Sugar , Community

Words: 1600

Published: 01/17/2020



The majority of the 220 million people around the world who suffer from diabetes have either Type 1 where the pancreas, no longer produces insulin and is usually caused by an autoimmune syndrome where the body attacks the pancreatic beta cells or Type 2 that develops from the body’s inability to metabolize insulin or glucose properly. . It is difficult to separate nutrition needs from lifestyle choices. An active individual requires more calories to maintain their activity levels, therefore lifestyle must always be looked at when considering dietary choices. Fortunately, both Type 1 and Type 2 Diabetes respond to nutrition and lifestyle choices.

Type 1 Diabetes responds to nutrition and lifestyle. Type 2 Diabetes responds to nutrition and lifestyle. Background Knowledge “A healthy diet is a crucial part of managing diabetes.” . This means developing healthy eating patterns including consistent times, amounts and balanced snacks and meals. A balanced diet improves health for everyone, but it is even more important for individuals at risk for diabetes, individuals who are suffering from prediabetes or people with either Type 1 or Type 2 diabetes. A balanced diet includes food from every food group. The largest part of a healthy diet should come from the foods such as, whole grain and vegetables like beans, potatoes, corn and peas. It should include several servings of other vegetables and fruit daily. Proteins should come from lean sources and dairy products should be low fat as well. Fats and sugars are most likely to disrupt insulin production and blood sugar levels and should be eaten only in small amounts. Salt is also linked to the high blood pressure associated with diabetes and salt intake should be monitored as well. . Whether an individual suffers from Type 1 diabetes or Type 2 diabetes they are at risk for other associated complications as well. These include heart and kidney disease. The individual dietary requirements must also take these considerations into account as well. . Diet plans must be adjusted to suit the individual; there is no single “Diabetes Diet” that will work for everyone. Healthy eating habits vary from person to person and across the span of a lifetime. Eating disorders and being overweight engenders more serious complications for individuals suffering from either type of diabetes than they do for people in the general population. The Mayo clinic reports that family history, genetics, geography, viral exposure and low vitamin D levels contribute to an individual’s likelihood of developing Type 1 diabetes. They also found that dietary factors play a role as well. The Mayo Clinic’s studies show that “Omega-3 fatty acids may offer some protection against type 1 diabetes.” Drinking water and foods containing nitrates on the other hand may increase the risk the risk of diabetes, One clinical trial found that introducing cereal into a baby’s diet is another factor that influences a tendency to develop diabetes and that between ages 3 and 7 months appears to be the optimal time for introducing cereal.” One way of controlling diabetes is by engaging in aerobic activity. However, that can also bring its own set of complications. Individuals who suffer from Type 1 diabetes need to coordinate medication or insulin. food and activities to maintain healthy glucose levels.. The New York Times reports that aerobic activity does more than help maintain a healthy wieght. It also helps increase sensitivity to insulin, it lowers blood pressure, and improves cholesterol levels.”. However, glucose levels swing dramatically during workouts. Because of blood sugar level swings people with type 1 diabetes need to monitor their glucose levels before during and after a workout. As with driving and operating machineery they should not engage in the activity if their blood sugar levels are outside a certain range. In the case of aerobic exercise that range is between 300 mg/dL as a high, or under 100 mg/dL. Individuals preparing for a workout should also be attentive to pre-workout snacks and wear protective footwear. . The Diabetes Prevention Program (DPP) was a multicenter clinical research study conducted by the National Diabetes Information Clearinghouse in conjunction with the National Institutes of Health and the W.S. Department of Health and Human Services. Their study used wight gain, lifestyle choices and drugs to influence the potential for diabetes. DPP study found that those participants who lost weight through dietary changes and increased activity reduced their chances of developing diabetes.”. This broad and ongoing study was conducted to look into diabetes prevention and control. The study utilized both lifestyle changes and medication. To do this they worked with 3,234 participants from 27 clinics nationwide broken into four treatment groups. All the participants were overweight and had prediabetes. In this study, 45% of the participants were from minority groups at increased risk of developing diabetes. These participants identified themselves as African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander. Genetic factors within these demographic groups seem to increase the likelihood of developing diabetes. The first group received training in diet, physical activity and behavior modification in an attempt to lose 7% of their body fat. The second group was treated with metformin twice a day. The third group received a placebo and information, but no training in diet and exercise. A fourth group was initially treated with the drug troglitazone (Rezulin) but treatment was cancelled because of potential side effects. . Initial results showed that all ethnic and gender groups, in the lifestyle intervention group-reduced their risk of developing diabetes by 58 percent. Lifestyle changes even more successful for individuals age 60 and older where the risk went down by 71%. About 5 percent of the lifestyle intervention group developed diabetes each year, as opposed to 11% of those in the placebo group. Those receiving medication also saw reduced rates of about 7.8% .

Medical Implications

Further analysis of the DPP data showed that changing diet and physical activity is effective in reducing the risk for both diabetes, cardiovascular disease, high blood pressure, urinary incontinence in women and metabolic syndrome. Metabolic syndrome is a specific group of risk factors that indicate a tendency to develop diabetes and heart disease. These include excess fat in the stomach and waist areas, high fasting blood glucose levels and high triglyceride levels. In one analysis, individuals who participated in the DPP in the lifestyle intervention group without metabolic syndrome at the beginning of the study were less likely to develop it. In another analysis, high blood pressure in DPP participants decreased in the lifestyle intervention group but, over time did not decrease for participants in the drug and placebo groups.. The lifestyle intervention group also had improved measures of triglyceride, HDL cholesterol, C-reactive protein and fibrinogen levels. . Studies at the Mayo Clinic found that keeping :blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.” . People who suffer from diabetes also tend to have complications that include heart disease, blood vessel disease, nerve damage (neuropathy), Kidney damage (nephropathy), eye damage, foot damage, skin problems, gum infections, osteoporosis, hearing problems and pregnancy complications. . Additional concerns affiliated with diabetes are raised by the possible situational circumstances associated with hypoglycemia. This can involve driving, working, pregnancy, child care and just growing older. Because hypoglycemia can occur at any time. Mayo clinic suggests testing for hypoglycemia before driving or engaging in any activity that carries a high risk for potential hypoglycemic individuals. If the blood sugar level is below 70 mg/dL the person should eat a snack and test again in 15 minutes. Low blood sugar slows the reaction time and makes it harder to concentrate so driving and activities like operating heavy machinery are particularly dangerous for someone who suffers from diabetes. This is one situation where attention to nutrition is vital for the diabetes sufferer.

Studies show that maintaining a healthy weight and appropriate caloric activity balance reduces an individual’s risk of developing either Type 1 or Type 2 diabetes. the risk for either Type 1 or Type 2 diabetes. The type of foods eaten are also important, to maintain homeostasis. Whole grains, vegetables and lean protein are beneficial dietary components. Refined sugars and carbohydrates cause blood sugar levels to spike, which is particularly bad for diabetics. Additionally, both diet and activity levels are interrelated in maintaining healthy blood sugar levels controlling diabetes and avoiding complications associated with either type of diabetes.

Works Cited

Arbunkle, K. "the Impact of Exercise & Nutrition on Diabetes?" 18 12 2010. Livstrong. 07 12 2012 . Mayo Clinic Staff. "Type 1 diabetes - Causes." 2012. The Mayo Clinic. 07 12 2012 . NDIC. "Diabetes Prevention Program (DPP)." 06 11 2012. National Diabetes Information Clearinghouse (NDIC). 07 12 2012 . New York Times. "Type 1 Diabetes Lifestyle Change." 07 12 2012. New York Times. 07 12 2012 . Slowik, MD FRCS, Guy. "How Does Diet Affect Diabetes?" 21 03 2012. eHealthMD. 07 12 2012 .


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  • Int J Health Sci (Qassim)
  • v.11(2); Apr-Jun 2017

Effect of diet on type 2 diabetes mellitus: A review

1 Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2 Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

Tahir Ansari

3 Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

Nadeem Shafique Butt

4 Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

Mohd Rashid Ab Hamid

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.


Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes. 1 DM is a combination of two words, “diabetes” Greek word derivative, means siphon - to pass through and the Latin word “mellitus” means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain. 2 , 3 With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as “a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin.” The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system. 4 DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of β cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake. 5 - 7

T2DM factors which can be irreversible such as age, genetic, race, and ethnicity or revisable such as diet, physical activity and smoking. 8 , 9


Globally, T2DM is at present one of the most common diseases and its levels are progressively on the rise. It has been evaluated that around 366 million people worldwide or 8.3% in the age group of 20-79 years had T2DM in 2011. This figure is expected to rise to 552 million (9.9%) by 2030. 10 This disease is associated with severe complications which affect patient’s health, productivity, and quality of life. More than 50% of people with diabetes die of cardiovascular disease (CVD) (primarily heart disease and stroke) and is a sole cause of end stage renal disease which requires either dialysis or kidney transplantation. It is also a major cause of blindness due to retinal damage in adult age group referred to as diabetic retinopathy (DR). People with T2DM have an increased risk of lower limb amputation that may be 25 times greater than those without the disease. This disease caused around 4.6 million deaths in the age-group of 20-79 years in 2011. 11

Physical Activity and Lifestyle

A large number of cross-sectional as well as prospective and retrospective studies have found significant association between physical inactivity and T2DM. 12 A prospective study was carried out among more than thousand nondiabetic individuals from the high-risk population of Pima Indians. During an average follow-up period of 6-year, it was found that the diabetes incidence rate remained higher in less active men and women from all BMI groups. 13 The existing evidence suggests a number of possible biological pathways for the protective effect of physical activity on the development of T2DM. First, it has been suggested that physical activity increases sensitivity to insulin. In a comprehensive report published by Health and Human Services, USA, 2015 reported that physical activity enormously improved abnormal glucose tolerance when caused by insulin resistance primarily than when it was caused by deficient amounts of circulating insulin. 14 Second, physical activity is likely to be most beneficial in preventing the progression of T2DM during the initial stages, before insulin therapy is required. The protective mechanism of physical activity appears to have a synergistic effect with insulin. During a single prolonged session of physical activity, contracting skeletal muscle enhances glucose uptake into the cells. This effect increases blood flow in the muscle and enhances glucose transport into the muscle cell. 15 Third, physical activity has also been found to reduce intra-abdominal fat, which is a known risk factor for insulin resistance. In certain other studies, physical activity has been inversely associated with intra-abdominal fat distribution and can reduce body fat stores. 16 Lifestyle and environmental factors are reported to be the main causes of extreme increase in the incidence of T2DM. 17

Patient’s Knowledge Regarding DM

Among the patients, diabetes awareness and management are still the major challenges faced by stakeholders worldwide. Poor knowledge related to diabetes is reported in many studies from the developing countries. 18 Some studies have suggested that the occurrence of diabetes is different in various ethnic groups. 19 Knowledge is a requirement to achieve better compliance with medical therapy. 20 According to a study conducted by Mohammadi 21 patient’s knowledge and self-care management regarding DM was not sufficient. Low awareness of DM affects the outcome of diabetes. Another study conducted in Slovakia by Magurová 22 compared two groups of patients (those who received diabetes education and those who did not). The results indicated that receiving diabetes education significantly increased awareness about the disease in patients ( p < 0.001). The study further concluded that having diabetes knowledge can notably improve patient’s quality of life and lessen the burden on their family. Dussa 23 conducted a cross-sectional study on assessment of diabetes awareness in India. The study concluded that level of diabetes awareness among patients and general population was low. Another study conducted in India by Shah 24 reported that 63% of T2DM patients did not know what DM is and the majority were also unaware about its complications.

According to the study conducted by Bani 25 in Saudi Arabia, majority of the patients 97.3% males and 93.1% females were unaware about the importance of monitoring diabetes, with no significant gender difference. Diabetes knowledge, attitude, and practice were also studied in Qatari type 2 diabetics. The patients’ knowledge regarding diabetes was very poor, and their knowledge regarding the effect of diabetes on feet was also not appreciable. 26 Results from a study conducted in Najran, Saudi Arabia 27 reported that almost half of the patients did not have adequate knowledge regarding diabetes disease. Males in this study had more knowledge regarding diabetes than female patients. Diabetes knowledge among self-reported diabetic female teachers was studied in Al-Khobar, Saudi Arabia. 28 The study concluded that diabetes knowledge among diabetic female teachers was very poor. It was further suggested that awareness and education about diabetes should be urgently given to sample patients. The knowledge of diabetes provides the information about eating attitude, workout, weight monitoring, blood glucose levels, and use of medication, eye care, foot care, and control of diabetes complications. 29

Relation between Diet and Type 2 DM

The role of diet in the etiology of T2DM was proposed by Indians as mentioned earlier, who observed that the disease was almost confined to rich people who consumed oil, flour, and sugar in excessive amounts. 30 During the First and Second World Wars, declines in the diabetes mortality rates were documented due to food shortage and famines in the involved countries such as Germany and other European countries. In Berlin, diabetes mortality rate declined from 23.1/100,000 in 1914 to 10.9 in 1919. In contrast, there was no change in diabetes mortality rate in other countries with no shortage of food at the same time period such as Japan and North American countries. 31 Whereas few studies have found strong association of T2DM with high intake of carbohydrates and fats. Many studies have reported a positive association between high intake of sugars and development of T2DM. 32 In a study, Ludwig 33 investigated more than 500 ethnically diverse schoolchildren for 19 months. It was found that for each additional serving of carbonated drinks consumed, frequency of obesity increased, after adjusting for different parameters such as dietary, demographic, anthropometric, and lifestyle.

A study was conducted which included the diabetic patients with differing degrees of glycemic control. There were no differences in the mean daily plasma glucose levels or diurnal glucose profiles. As with carbohydrates, the association between dietary fats and T2DM was also inconsistent. 34 Many of prospective studies have found relations between fat intake and subsequent risk of developing T2DM. In a diabetes study, conducted at San Louis Valley, a more than thousand subjects without a prior diagnosis of diabetes were prospectively investigated for 4 years. In that study, the researchers found an association between fat intake, T2DM and impaired glucose tolerance. 35 , 36 Another study observed the relationship of the various diet components among two groups of women, including fat, fiber plus sucrose, and the risk of T2DM. After adjustment, no associations were found between intakes of fat, sucrose, carbohydrate or fiber and risk of diabetes in both groups. 37

Recently, evidence suggested a link between the intake of soft drinks with obesity and diabetes, resulting from large amounts of high fructose corn syrup used in the manufacturing of soft drinks, which raises blood glucose levels and BMI to the dangerous levels. 38 It was also stated by Assy 39 that diet soft drinks contain glycated chemicals that markedly augment insulin resistance. Food intake has been strongly linked with obesity, not only related to the volume of food but also in terms of the composition and quality of diet. 40 High intake of red meat, sweets and fried foods, contribute to the increased the risk of insulin resistance and T2DM. 41 In contrast, an inverse correlation was observed between intake of vegetables and T2DM. Consumption of fruits and vegetables may protect the development of T2DM, as they are rich in nutrients, fiber and antioxidants which are considered as protective barrier against the diseases. 42 Recently, in Japanese women, a report revealed that elevated intake of white rice was associated with an increased risk of T2DM. 43 This demands an urgent need for changing lifestyle among general population and further increase the awareness of healthy diet patterns in all groups.

Dietary Knowledge of Type 2 Diabetics

American Diabetes Association has defined self-dietary management as the key step in providing the diabetics, the knowledge and skill in relation with treatment, nutritional aspects, medications and complications. A study showed that the dietary knowledge of the targeted group who were at high risk of developing T2DM was poor. Red meat and fried food were consumed more by males as compared to females. The percent of males to females in daily rice consumption was significantly high. 44

In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics. 45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman 46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller 47 stated that patients’ food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05). 48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia 25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.

National Center for Health Statistics reported that socioeconomic status plays an important role in the development of T2DM; where it was known as a disease of the rich. 49 On the contrary, the same reference reported that T2DM was more prevalent in lower income level and in those with less education. The differences may be due to the type of food consumed. Nutritionists advised that nutrition is very important in managing diabetes, not only type but also quantity of food which influences blood sugar. Meals should be consumed at regular times with low fat and high fiber contents including a limited amount of carbohydrates. It was observed that daily consumption of protein, fat and energy intake by Saudi residents were higher than what is recommended by the International Nutritional Organization. 50

Attitude of Type 2 Diabetics Toward Food

DM can be controlled through improvement in patient’s dietary knowledge, attitudes, and practices. These factors are considered as an integral part of comprehensive diabetes care. 51 Although the prevalence of DM is high in gulf countries, patients are still deficient in understanding the importance of diet in diabetes management. 52 Studies have shown that assessing patients’ dietary attitude may have a considerable benefit toward treatment compliance and decrease the occurrence rate of complications as well. 52 A study conducted in Egypt reported that the attitude of the patients toward food, compliance to treatment, food control with and without drug use and foot care was inadequate. 53 Another study presented that one-third of the diabetic patients were aware about the importance of diet planning, and limiting cholesterol intake to prevent CVD. Various studies have documented increased prevalence of eating disorders and eating disorder symptoms in T2DM patients. Most of these studies have discussed about the binge eating disorder, due to its strong correlation with obesity, a condition that leads to T2DM. 53 Furthermore, a study revealed that the weight gain among diabetic patients was associated with the eating disorder due to psychological distress. 54 In another study that examined eating disorder-related symptoms in T2DM patients, suggested that the dieting-bingeing sequence can be applied to diabetics, especially obese diabetic patients. 55 Unhealthy eating habits and physical inactivity are the leading causes of diabetes. Failure to follow a strict diet plan and workout, along with prescribed medication are leading causes of complications among patients of T2DM. 56 Previous studies 57 conducted in Saudi Arabia have reported that diabetic patients do not regard the advice given by their physicians regularly regarding diet planning, diet modification and exercise.

Dietary Practices of Type 2 Diabetics

Diabetic’s dietary practices are mainly influenced by cultural backgrounds. Concerning each of the dimensions of dietary practices, there were significant positive relationships between knowledge regarding diabetic diet and dietary practices. Knowledge was a salient factor related to dietary behaviors control. 46 Moreover, patients’ knowledge on a recommended diet indicates their understanding of dietary guidelines which influenced their food selection and eating patterns. 47 The association between dietary knowledge and dietary practices among T2DM patients in the previous studies were inconsistent. Another study revealed that there was no relationship between dietary knowledge and compliance of dietary practices. 58 On the other hand, the same study found that a high dietary knowledge score was associated with following dietary recommendations and knowledgeable patients performed self-management activities in a better way. Dietary knowledge significantly influences dietary practices. In Indonesia, a study was conducted to measure dietary practices among diabetic patients, which elaborated that the Indonesian people, preferred to consume high-fat foods which lead to an increased risk of CVD. 59 The trend of skipping breakfast has dramatically increased over the past 10 years in children, adolescents, and adults. 60 , 61 There is increasing evidence that skipping breakfast is related with overweight and other health issues. 62 In addition, frequent eating or snacking may also increase the body weight and risk of metabolic diseases. 63 , 64 Rimm 65 demarcated western and prudent dietary patterns. The prudent dietary pattern was characterized by increased consumption of fish, poultry, various vegetables and fruits whereas; the western dietary pattern was characterized by an increased consumption of processed and red meat, chips, dairy products, refined grains, and sweets and desserts. These patterns were previously associated with T2DM risk. The glycemic index is an indicator of the postprandial blood glucose response to food per gram of carbohydrate compared with a reference food such as white bread or glucose. Hence, the glycemic load represents both the quality and quantity of the carbohydrates consumed. 66 - 69 Another study conducted in Lebanon demonstrated direct correlation of the refined grains and desserts and fast food patterns with T2DM, however, in the same study an inverse correlation was observed between the traditional food pattern and T2DM among Lebanese adults. 70

Type 2 Diabetes Complications

DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patient’s quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%. 71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%). 72 - 76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes. 77

Relation between Dietary Practices and Diabetes Complications

Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients. 78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia. 79 , 80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients. 81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management. 82 In addition, an individual’s food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes. 83 - 85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy. 86 Dietary habits are essential elements of individual cardiovascular and metabolic risk. 87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD. 88

The review of various studies suggests that T2DM patients require reinforcement of DM education including dietary management through stakeholders (health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life. The overall purpose of treating T2DM is to help the patients from developing early end-organ complications which can be achieved through proper dietary management. The success of dietary management requires that the health professionals should have an orientation about the cultural beliefs, thoughts, family, and communal networks of the patients. As diabetes is a disease which continues for the lifetime, proper therapy methods with special emphasis on diet should be given by the healthcare providers in a way to control the disease, reduce the symptoms, and prevent the appearance of the complications. The patients should also have good knowledge about the disease and diet, for this purpose, the health-care providers must inform the patients to make changes in their nutritional habits and food preparations. Active and effective dietary education may prevent the onset of diabetes and its complications.


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