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Carbohydrates in the treatment and prevention of type 2 diabetes

24 / 05 / 15

Mann J & Te Morenga L (2015) Carbohydrates in the treatment and prevention of Type 2 diabetes. Diabetic Medicine 32:572-575    

Mann and Te Morenga provide a commentary in Diabetic Medicine on the role of carbohydrates in the treatment and prevention of Type 2 diabetes. The aim was to discuss evolving research in the area, in particular focussing on dietary sugars. 

They acknowledge the outcome of their previous meta-analysis which showed the change in body fatness that occurs with modifying intake of sugars, appears to be mediated via changes in energy intakes. This was because strict isoenergetic exchange of sugars with other carbohydrates was not seen to be associated with change in body weight. They note that the potential benefit from a relatively simple dietary measure would seem to justify the inclusion of advice to reduce dietary sugars in recommendations aimed at preventing diabetes or treating those with Type 2 diabetes, who are also overweight. They query whether there are reasons beyond calorie control, to make such a recommendation, such as effect on risk of Type 2 diabetes or cardiometabolic risk. Although their previous meta-analysis found weak direct evidence that free sugars may effect cardiometabolic risk, it is strengthened using data from cohort studies. 

The authors discuss the new World Health Organisation guideline on free sugars. They note that although it is based on dental caries evidence, the benefits of a reduction in sugars in terms of obesity and cardiometabolic risk suggest that the guideline might be applied to those at risk of type 2 diabetes.

Regarding diet patterns and Type 2 diabetes, a range of techniques can help achieve and maintain weight loss and improve metabolic indices. The nature of the dietary carbohydrate is essential when considering isoenergetic diets. Specifically the authors suggest people with insulin resistance should limit potatoes, white rice and bread. They state that those who are insulin resistant and hyper-triglyceridaemic should maintain total carbohydrate intake at the lower end of the acceptable range.