Dietary recommendations for persons with type 2 diabetes mellitus

Preface

This practice guideline is aimed at all professional groups caring for people with type 2 diabetes mellitus (T2Dm). In addition to the multifaceted aspects of nutrition in diabetes, there is a particular call for individualization of therapy, counseling, empowerment, and diabetes self-management [1] [2] [3]. Therefore, the Nutrition Committee of the DDG has set the goal to compile practice guidelines on nutrition as target group-specific as possible with the highest available evidence. In doing so, it is considered necessary to treatment forms separately presentation since the therapeutic significance of nutrition differs significantly in each case and must be seen against the background of different drug therapy components.

T2Dm is characterized by a progressive course in terms of β-cell insufficiency, which progresses at different rates in different individuals [4] [5] [6] [7]. Against this background, patients with T2Dm have both quite different characteristics and treatment regimens [8].

For patients with special life circumstances, e. g., sarcopenia and need for long-term care, diets must be designed taking strong consideration of personal preferences and with an emphasis on meeting protein requirements.

Overall, as a result, nutritional therapy needs to be highly individualized to realize its full potential.

The option of individualized nutritional counseling, including via telemedicine, should therefore be used more widely and intensively in people with T2Dm. The general goals are to promote balanced eating habits, provide training on appropriate portion sizes, and address individual dietary needs while maintaining enjoyment of food and providing practical tools for meal planning. Individualized nutrition counseling sessions include evidence-based topics that should be provided by qualified and appropriately certified nutrition professionals (dietitian, nutritionist or ecotrophologist).

The nutritional therapy plan must also be coordinated and continuously aligned with the overall management strategy, including medications administered, physical activity, etc.

In addition, people with prediabetes and excess weight/obesity should be referred to an intensive lifestyle intervention program that includes individualized goal-setting components, as defined, for example, by the S3 Guideline Prevention and Therapy of Obesity (S3-Leitlinie Prävention und Therapie der Adipositas). Since this service is not yet a standard benefit of the statutory health insurance, at minimum individualized nutrition counseling should be provided with partial cost coverage according to § 43 German Social Security Code (SGB).

Another important recommendation is the referral of adults with diabetes to comprehensive diabetes self-management training and support (Diabetes-Selbstmanagementschulung und -unterstützung - DSMES) according to national standards.

This practice guideline represents the summary and evaluation of the literature by the Nutrition Committee of the DDG on selected nutritional aspects in the management of T2Dm. Regular updating and, if necessary, supplementation is planned. In doing so, the evidence - if available - was assessed in the context of literature research based on systematic reviews or meta-analyses. Original papers were also used for topics without the availability of such reviews.

Publication History

Article published online:
31 March 2022

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