CC BY-NC-ND 4.0 · Journal of Social Health and Diabetes 2018; 06(02): 065-071
DOI: 10.1055/s-0038-1675684
Review Article
NovoNordisk Education Foundation

Optimizing Macronutrients in People with Diabetes

Lovely Gupta
1   Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
,
Priti Rishi Lal
1   Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
,
Deepak Khandelwal
2   Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
› Author Affiliations
Further Information

Publication History

Publication Date:
12 November 2018 (online)

Abstract

Diverse dietary practices and nutritional counseling strategies are followed in the management of diabetes and its comorbidities. The dietary approaches practiced in India make use of calorie and nutrient counting to ensure patient-centered nutrition therapy in diabetes management. Macronutrient modulation is a central pillar of patient-centered medical nutrition therapy (MNT). Carbohydrates (CHO) are considered as the predominant macronutrient affecting postprandial blood glucose levels. The insulin-to-CHO ratio is used for calculating mealtime insulin doses among patients on insulin regimen. The aim of this article is to highlight challenges faced in planning MNT, modifying recommended dietary allowances for persons with diabetes, and suggesting solutions to overcome these. It also aims to understand the requirement of individual macronutrients and their impact on glycemia as well as insulin dose adjustment.

 
  • References

  • 1 World Health Organization India. Diabetes Available at: http://www.searo.who.int/india/topics/diabetes_mellitus/en/ Accessed September 7, 2018
  • 2 Diet in diabetes. Available at: http://www.apiindia.org/pdf/medicine_update_2011/24_diet_in_diabetes Accessed August 13, 2018
  • 3 Evert AB, Boucher JL, Cypress M. et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37 (Suppl. 01) S120-S143
  • 4 Shimizu T, Nathan DM, Buse JB. et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. [in Japanese] Nihon Rinsho 2012; 70 (Suppl. 03) 591-601
  • 5 Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018; 361: k2234
  • 6 Myers EF, Trostler N, Varsha V, Voet H. Insights from the Diabetes in India Nutrition Guidelines Study: adopting innovations using a knowledge transfer model. Topics Clin Nutr 2017; 32 (01) 69-86
  • 7 American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 01) S55-S64
  • 8 Ramlo-Halsted BA, Edelman SV. The natural history of type 2 diabetes. Implications for clinical practice. Prim Care. 1999; 26 (04) 771-789
  • 9 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetologia. 2012; 55 (06) 1577-1596
  • 10 Type 1 diabetes mellitus in children and adolescents in India. Clinical practice guidelines 2011 Available at: http://www. ispae.org.in/download_docs/Diabetes_guideline_for_Web.pdf Accessed September 3, 2018.
  • 11 Jain R, Handa A, Tiwari D, Jain P, Gupta A. Nutrition in diabetes. Journal, Indian Academy of Clinical Medicine 2014; 15 (02) 125-131
  • 12 Gupta L, Khandelwal D, Singla R, Gupta P, Kalra S. Pragmatic dietary advice for diabetes during Navratris. Indian J Endocrinol Metab 2017; 21 (01) 231-237
  • 13 Rušavý Z, Žourek M. Composition of macronutrients in the diabetic diet. [article in Czech] Vnitr Lek 2016; 62 (11) (Suppl. 04) S94-S99
  • 14 ICMR guidelines for management of type 2 diabetes 2018. Available at: https://medibulletin.com/wp-content/uploads/2018/05/ICMR.diabetesGuidelines.2018.pdf Accessed September 27, 2018
  • 15 Bajaj S. RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017. Int J Diabetes Dev Ctries 2018; 38 (01) (Suppl. 01) 1-115
  • 16 Gray A. Nutritional recommendations for individuals with diabetes. [Updated 2015 May 31]. In: De Groot LJ, Chrousos G, Dungan K. et al., eds. Endotext [Internet] South Dartmouth, MA: MDText.com, Inc. 2000; Available at: https://www.ncbi.nlm.nih.gov/books/NBK279012/
  • 17 Rocco MV, Berns JS. National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis 2012; 60 (05) 850-886
  • 18 Westerterp-Plantenga MS, Lemmens SG, Westerterp KR. Dietary protein—its role in satiety, energetics, weight loss and health. Br J Nutr 2012; 108 (Suppl. 02) S105-S112
  • 19 Millward DJ. The nutritional value of plant-based diets in relation to human amino acid and protein requirements. Proc Nutr Soc 1999; 58 (02) 249-260
  • 20 Millward DJ, Jackson AA. Protein/energy ratios of current diets in developed and developing countries compared with a safe protein/energy ratio: implications for recommended protein and amino acid intakes. Public Health Nutr 2004; 7 (03) 387-405
  • 21 Friedman M. Nutritional value of proteins from different food sources. A review. J Agric Food Chem 1996; 44 (01) 6-29
  • 22 Gupta L, Khandelwal D. Pragmatic selection of cooking oils. J Pak Med Assoc 2017; 67 (06) 957-958
  • 23 Dyson PA, Twenefour D, Breen C. et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med 2018; 35 (05) 541-547
  • 24 Gupta L, Khandelwal D, Kalra S. Increasing fibre in South Asian Diets. J Pak Med Assoc 2018; 68 (07) 1135-1136
  • 25 ICMR issues new guidelines for type 2 diabetes management as patient numbers touch 72.9 million. Available at: http://www.pharmabiz.com/NewsDetails.aspx?aid=108719&sid=1 Accessed May 8, 2018
  • 26 Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr 2013; 97 (03) 505-516
  • 27 Kalra S, Das AK, Raghupathy P. et al. Current indicators of nutritional care in children with type 1 diabetes in India: do we need a national nutritional guideline?. Indian J Endocrinol Metab 2017; 21 (05) 670-678
  • 28 Mosso C, Halabi V, Ortiz T, Hodgson MI. Dietary intake, body composition, and physical activity among young patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2015; 28 (07) (08) 895-902
  • 29 Shetty PS. Nutrition transition in India. Public health nutrition 2002; 5 1a 175-182
  • 30 Bhattacharya M. A historical exploration of Indian diets and a possible link to insulin resistance syndrome. Appetite 2015; 9 (05) 5-421
  • 31 Joshi SR, Bhansali A, Bajaj S. et al. Results from a dietary survey in an Indian T2DM population: a STARCH study. BMJ Open 2014; 4 (10) e005138
  • 32 Parthasarathy LS, Chiplonkar SA, Khadilkar AV, Khadilkar VV. Dietary modifications to improve micronutrient status of Indian children and adolescents with type 1 diabetes. Asia Pac J Clin Nutr 2015; 24 (01) 73-82
  • 33 Sahay BK. Dietary carbohydrate content in Indian diabetic patients. Med Update 2012; 22: 235-239
  • 34 Lin X, Chen C, Lin D. et al. Dietary glycemic load and metabolic status in newly diagnosed type 2 diabetes in southeastern China. Asia Pac J Clin Nutr 2018; 27 (02) 375-382
  • 35 Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38 (06) 1008-1015
  • 36 Bell KJ, Gray R, Munns D. et al. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr 2014; 68 (09) 1055-1059
  • 37 Paterson MA, Smart CE, Lopez PE. et al. Influence of dietary protein on postprandial blood glucose levels in individuals with type 1 diabetes mellitus using intensive insulin therapy. Diabet Med 2016; 33 (05) 592-598
  • 38 Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care 2013; 36 (04) 810-816
  • 39 Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P. Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 1984; 7 (05) 465-470
  • 40 Nuttall FQ, Gannon MC. Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects. Diabetes Care 1991; 14 (09) 824-838
  • 41 Layman DK, Boileau RA, Erickson DJ. et al. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr 2003; 133 (02) 411-417
  • 42 Kordonouri O, Hartmann R, Remus K, Bläsig S, Sadeghian E, Danne T. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy. Pediatr Diabetes 2012; 13 (07) 540-544
  • 43 Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther 2012; 14 (01) 16-22
  • 44 Bao J, Gilbertson HR, Gray R. et al. Improving the estimation of mealtime insulin dose in adults with type 1 diabetes: the Normal Insulin Demand for Dose Adjustment (NIDDA) study. Diabetes Care 2011; 34 (10) 2146-2151
  • 45 Pankowska E, Kordonouri O. The complex food counting system in managing children and young people with type 1 diabetes. Diabetes Care for Children and Young People 2013; 2: 68-70
  • 46 Hibbert-Jones E. Fat and protein counting in type 1 diabetes. Practical Diabetes 2016; Sep 33 (07) 243-247
  • 47 Herman WH. Approaches to glycemic treatment sec. 7: in standards of medical care in diabetes. Diabetes Care 2015; 38 (10) e175
  • 48 Garden L, Paterson K. Macronutrients and type 1 diabetes. [internet]. 2014 Oct 29; Diapedia 8105345813 rev. no. 6. Available at: https://www.diapedia.org/8105345813/rev/6
  • 49 Tascini G, Berioli MG, Cerquiglini L. et al. Carbohydrate counting in children and adolescents with type 1 diabetes. Nutrients 2018; 10 (01) 109
  • 50 Krebs JD, Arahill J, Cresswell P, Weatherall M, Parry-Strong A. The effect of additional mealtime insulin bolus using an insulin-to-protein ratio compared to usual carbohydrate counting on postprandial glucose in those with type 1 diabetes who usually follow a carbohydrate-restricted diet: a randomized cross-over trial. Diabetes Obes Metab 2018; 20 (10) 2486-2489
  • 51 Chan JC, Gagliardino JJ, Baik SH. et al IDMPS Investigators. Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care 2009; 32 (02) 227-233
  • 52 Patel M, Patel IM, Patel YM, Rathi SK. Factors associated with consumption of diabetic diet among type 2 diabetic subjects from Ahmedabad, Western India. J Health Popul Nutr 2012; 30 (04) 447-455
  • 53 Wangnoo SK, Maji D, Das AK. et al. Barriers and solutions to diabetes management: an Indian perspective. Indian J Endocrinol Metab 2013; 17 (04) 594-601
  • 54 Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. Int J Diabetes Dev Ctries 2009; 29 (03) 103-109
  • 55 Streisand R, Monaghan M. Young children with type 1 diabetes: challenges, research, and future directions. Curr Diab Rep 2014; 14 (09) 520
  • 56 Kesavadev J, Sadikot SM, Saboo B. et al. Challenges in type 1 diabetes management in South East Asia: descriptive situational assessment. Indian J Endocrinol Metab 2014; 18 (05) 600-607
  • 57 Weinger K, Beverly EA. Barriers to achieving glycemic targets: who omits insulin and why?. Diabetes Care 2010; 33 (02) 450-452
  • 58 Kalra S, Joshi S, Baruah M. Medical nutrition therapy for diabetes: the challenge in India. J Med Nutr Nutraceut 2012; 1 (01) 3-4
  • 59 Joseph M, Gupta RD, Gangadhara P. Barriers to nutritional practices and dietary education in patients with type 1 diabetes mellitus in India. J Global Diabetes Clin Metabol 2017; 6: 2
  • 60 Whelan WJ, Hollar D, Agatston A, Dodson HJ, Tahal DS. The glycemic response is a personal attribute. IUBMB Life 2010; 62 (08) 637-641
  • 61 Nguyen P, Dumon H, Biourge V, Pouteau E. Measurement of postprandial incremental glucose and insulin changes in healthy dogs: influence of food adaptation and length of time of blood sampling. J Nutr 1998; 128 (12) Suppl) 2659S-2662S
  • 62 Gupta L, Khandelwal D, Kalra S. Carbohydrate counting-1: South Asian framework. J Pak Med Assoc 2017; 67 (08) 1296-1298
  • 63 Hoffman JR, Falvo MJ. Protein-which is best?. J Sports Sci Med 2004; 3 (03) 118-130