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Progress has been made in understanding the best dietary advice for diabetes but broader problems exist.
#REFERENCE MANAGER 12 WORD JOURNAL OF DIABETES HOW TO#
Family doctors and hospital clinics should collect this information routinely but how to do this is a challenge.
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7 Although systems are usually in place to record and monitor process measures for diabetes care in medical records, dietary information is often neglected, even though at least modest attention to diet is needed to achieve adequate glycaemic control. There is wide variation in the use of dietary modification alone to manage type 2 diabetes: for instance, estimates of fewer than 5-10% of patients with type 2 diabetes in India 6 and 31% in the UK are reported, although patients treated by lifestyle measures may be less closely managed than patients on medication for type 2 diabetes. In resource poor settings, when type 2 diabetes is diagnosed, often the patient leaves the clinic with a list of new medications and little else. In many settings, outside of specialised diabetes centres where trained nutritionists/educators are available, advice on nutrition for diabetes is, at best, a printed menu given to the patient. 4 5 Moreover, talking to patients about nutrition is time consuming. Most physicians are not trained in nutrition interventions and this is a barrier to counselling patients. Although most diabetes guidelines recommend starting pharmacotherapy only after first making nutritional and physical activity lifestyle changes, this is not always followed in practice globally.
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Medical nutrition therapy was introduced to guide a systematic and evidence based approach to the management of diabetes through diet, and its effectiveness has been demonstrated, 3 but difficulties remain. The idea of being on a “diet” for a chronic lifelong condition like diabetes is enough to put many people off as knowing what to eat and maintaining an optimal eating pattern are challenging. However, nutrition is also one of the most controversial and difficult aspects of the management of type 2 diabetes. 2 The importance of nutrition in the management and prevention of type 2 diabetes through its effect on weight and metabolic control is clear. Diet is a leading contributor to morbidity and mortality worldwide according to the Global Burden of Disease Study carried out in 188 countries. 1 Urgent solutions for slowing, or even reversing, this trend are needed, especially from investment in modifiable factors including diet, physical activity, and weight. Why dietary management matters but is difficult to implementĭiabetes is one of the biggest global public health problems: the prevalence is estimated to increase from 425 million people in 2017 to 629 million by 2045, with linked health, social, and economic costs.