Ernährungstherapie bei Diabetes

Die Ernährungstherapie bei Patienten mit Typ-1- und Typ-2-Diabetes basiert auf einer gesunden Ernährung (ausgewogene, energiemodifizierte und ballaststoffreiche überwiegend pflanzliche Mischkost) und ergänzt diese entsprechend der Komorbiditäten der Erkrankung gezielt durch evidenzbasierte Erkenntnisse aus der Ernährungstherapie von Hypertonie, Dyslipidämie und Adipositas, um den bestmöglichen therapeutischen Nutzen zu erreichen.

Abstract

Nutritional therapy of patients with type 1 or type 2 diabetes is based on a healthy balanced diet that is complemented by evidenced based guidelines for nutritional counselling of comorbidities like obesity, hypertension and dyslipidemia. Dietary recommendations are further individualized based on medication (i. e. for prevention of hypoglycemia) and according to personal preferences (e. g. regarding macronutrient composition). Avoidance of long-term complications and improvement of prognosis are main objectives of nutritional therapy in the vulnerable group of patients with diabetes. In normal weight patients with type 1 diabetes, optimal glycemic control is the major target of counselling. In patients with type 2 diabetes, reduction of cardiovascular risk is also in the focus of therapy. In contrast to non-diabetic patients the treatment of dyslipidemia in type 2 diabetes not only requires lowering of LDL cholesterol by limitation of saturated fat intake but also needs a strategy for reduction of triglyceride levels. Both therapeutic aims can be best achieved by a high fiber low glycemic load diet with a high proportion of oleic acid.

Kernaussagen

• Bei normalgewichtigen Patienten mit Typ-1-Diabetes steht die optimale Einstellung des Blutzuckerspiegels im Vordergrund der diätetischen Bemühungen.

• Bei Typ-2-Diabetikern ist neben der Einstellung des Blutzuckers vor allem die diätetische Behandlung von Übergewicht und Adipositas sowie von Hypertonie und Fettstoffwechselstörungen zur Senkung des kardiovaskulären Risikos entscheidend. Im Gegensatz zu Nichtdiabetikern ist hierfür nicht nur eine Senkung des LDL-Cholesterins, sondern auch die Reduktion des Triglyzeridspiegels wichtig.

• Die Verbesserung der Glykämie und der Blutfette wird am besten mit einer kohlenhydratmodifizierten Diät (ballaststoffreich mit niedriger glykämischer Last) mit einem hohen Anteil an einfach ungesättigten Fettsäuren erreicht.

Schlüsselwörter

Typ-1-Diabetes - Typ-2-Diabetes - Ernährungstherapie - Fettstoffwechselstörungen - glykämischer Index

Keywords

type 1 diabetes - type 2 diabetes - medical nutritional therapy - dyslipidemia - glycemic index

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