Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes

The effectiveness of medical nutrition therapy (MNT) in the management of diabetes has been well established (1). Previous reviews have provided comprehensive recommendations for MNT in the management of diabetes (2,3). The goals of MNT are to 1) attain andmaintain optimal blood glucose levels, a lipid and lipoprotein profile that reduces the risk of macrovascular disease, and blood pressure levels that reduce the risk for vascular disease; 2) prevent and treat the chronic complications of diabetes by modifying nutrient intake and lifestyle; 3) address individual nutrition needs, taking into account personal and cultural preferences and willingness to change; and 4) maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence (4). The literature on nutrition as it relates to diabetes management is vast. We undertook the specific topic of the role of macronutrients, eating patterns, and individual foods in response to continued controversy over independent contributions of specific foods and macronutrients, independent of weight loss, in the management of diabetes. The position of the American Diabetes Association (ADA) on MNT is that each person with diabetes should receive an individualized eating plan (4). ADA has received numerous criticisms because it does not recommend one specific mix of macronutrients for everyone with diabetes. The previous literature review conducted by ADA in 2001 supported the idea that there was not one ideal macronutrient distribution for all people with diabetes. This review focuses on literature that has been published since that 2001 date (5). This systematic review will be one source of information considered when updating the current ADANutrition Position Statement (4). Other systematic reviews and key research studies that may not be included in this review will also be considered. When attempting to tease out the role of macronutrients from other dietary and lifestyle factors, two critical components of MNTdenergy balance and a healthful eating patterndare not addressed. While both are critical components in the management of diabetes as well as the secondary prevention of complications and promotion of health, these topics are beyond the scope of this particular review. The following questions are addressed in this review: