Fruits, vegetables, and whole grains good for diabetes management, recommend EASD

EASD's Diabetes and Nutrition Study Group (DNSG), in its recommendation published in Diabetologia, has advised patients with diabetes to consume more fruits, vegetables, whole grains, nuts, and legumes. People with diabetes should avoid meat, especially red and processed meats, sugar-sweetened beverages, sodium, and refined grains.

The group found that multiple dietary patterns, including the Mediterranean diet, the vegetarian diet and the Nordic diet, could all provide benefits for people living with diabetes.

The authors wrote, "The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes."

"The paper was composed to provide evidence-based recommendations and guidance on macronutrients, food, dietary patterns, and broader lifestyle context for type 2 diabetes prevention and management," they wrote. "Our findings suggest that a range of foods and dietary patterns are appropriate for diabetes management and key recommendations for people with diabetes is largely similar to those for the general population."

The authors commissioned new systematic reviews and meta-analyses on critical topics to update the recommendation and drew on the broader evidence available. The updated version included advice related to environmental sustainability, dietary patterns, patient support, food processing, and type 2 diabetes remission.

For the prevention of type 2 diabetes, the authors recommend that overweight/obese people should lose at least 5% of their body weight to reduce their risk. Also, a healthy dietary pattern is recommended, including not smoking, avoiding excess weight, and regular physical activity.

The authors recommend evidence-based treatments, various weight loss diets, and macronutrient compositions for energy balance and weight management. They also recommend using nutritionally complete low-energy formula products, either temporarily for weight loss induction as 'total diet replacement' or by replacing 1-2 meals per day. They caution against extreme high-carbohydrate or very low-carbohydrate ketogenic diets. They suggest that type 2 diabetes remission can be achieved through sustained weight loss in obese/overweight people.

The group recommends foods naturally high in dietary fibre, mainly minimally processed whole grains, vegetables, legumes, seeds, nuts and whole fruits for carbohydrate intake. Sugar intake should be below 10% of a person's total energy intake, and non-nutritive sweeteners may be used as a sugar replacement.

The document states, "Dietary fats should come from plant-based foods high in monounsaturated and polyunsaturated fats. Saturated fats should comprise less than 10% of a person's total energy, and trans fats should comprise less than 1% of total energy."

"While reducing saturated fats, the replacement should be with plant-based polyunsaturated fats comprising both n-6 and n-3 fatty acids, and monounsaturated fats found in seeds, nuts, and non-hydrogenated non-tropical vegetable oils."

Protein intake may be increased to 23% to 32% short term in the context of a weight-loss diet for people with type 2 diabetes and obesity or overweight with an eGFR of more than 60 mL/min/1.73 m2. For a diabetic person with normal weight, protein intake should comprise 10% to 20% of total energy intake; a higher intake is recommended for people aged 65 years and above. For people with moderate diabetic nephropathy, the group recommends a protein intake of 10% to 15%.

Whole grains, vegetables and fruits, legumes, nuts, and seeds are recommended to improve blood glucose control, cardiovascular risk factors, and body weight.

Any dietary patterns emphasizing those foods, including the Mediterranean diet, Nordic diet and vegetarian diet, are recommended for people with diabetes. The study group also listed foods and drinks to avoid, including meat, sugar-sweetened beverages, sweets and refined grains.

The group noted that while the recommendations are broad, more research is needed to promote long-term behavioural change in people with diabetes.