Diabetes mellitus is a heterogeneous group of disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. The chronic hyperglycemia of diabetes mellitus is associated with end organ damage, dysfunction, and failure, including the retina, kidney, nervous system, heart, and blood vessels (1).

• General recommendations

These are the recommendations of the American Diabetes Association (2).

Individuals who have prediabetes or diabetes should receive individualized Medical nutrition therapy (MNT) as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT.

Because MNT can result in cost-savings and improved outcomes, MNT should be adequately covered by insurance and other payers.

• Energy balance, overweight, and obesity

Weight loss is recommended for all overweight or obese individuals who have or are at risk for diabetes.

For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). 

For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed.

Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss.

• Recommendations for primary prevention of diabetes

Among individuals at high risk for developing type 2 diabetes, structured programs that emphasize lifestyle changes that include moderate weight loss (7% body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended.

Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).

Individuals at risk for type 2 diabetes should be encouraged to limit their intake of sugar-sweetened beverages.

Walk or run?

The significant long-term impact of Diabetes mellitus (T2D) on life and health span has led to many endeavors to block the development of diabetes mellitus as one means to prevent the complications. Hence, it was concluded that equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for T2D (3).

References_______________________________________________________________________

(1) General aspects of diabetes mellitus.  Alam U, Asghar O, Azmi S, Malik RA.  Handb Clin Neurol. 2014;126:211-22. doi: 10.1016/B978-0-444-53480-4.00015-1. Review. 

(2) Standards of medical care in diabetes--2012.  American Diabetes Association.  Diabetes Care. 2012 Jan;35 Suppl 1:S11-63. doi: 10.2337/dc12-s011. 

(3) Recent highlights of ATVB: diabetes mellitus.  Schmidt AM. Arterioscler Thromb Vasc Biol. 2014 May;34(5):954-8. doi: 10.1161/ATVBAHA.114.303522