Weight LossWeight loss targeting 7% of body weight is recommended for all who are overweight or obese if they have diabetes or are at high risk for it. (This amount of weight reduction has been shown both to help prevent diabetes and to improve the outlook for those who are already diabetic.) The American Diabetes Association's "Standards of Medical Care in Diabetes-2012" says "either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years)." Then it says "For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed." This indicates that there remains some caution about recommending carbohydrate reduction. It's probably worth noting that the statement says that recommendations for monitoring are not based on "evidence" (as most of their recommendations are), but on "expert opinion". The part about adjusting medications is very important, as reducing carbohydrate in the diet will almost inevitably mean that less medication will be needed.
Bariatric surgery is also an option for adults who are obese (BMI greater than 35) and diabetes "especially if the diabetes or associated comorbidities are difficult to control with lifestyle and pharmacologic therapy".
The other weight loss recommendation is that "Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss." For diabetes prevention, a minimum of 150 minutes of moderate activity per week is recommended.
Blood Glucose Control
- The current ADA recommendations of the role of diet in diabetes management are as follows, quoting from the statment:
- The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.
- Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.
- Saturated fat intake should be <7% of total calories.
- Intake of trans fat should be minimized.
- It is recommended that individualized meal planning include optimization of food choices to meet recommended daily allowance (RDA)/dietary reference intake (DRI) for all micronutrients (vitamins and minerals.
American Diabetes Association. Standards of Medical Care in Diabetes-2012. Diabetes Care. January 2012 vol. 35 no. Supplement 1 S11-S63.