Medical Nutrition Strategies in Glycemic Management in Patients with Type 2 Diabetes

doi:10.12114/j.issn.1007-9572.2021.00.033

Abstract

Abstract:

Medical nutrition therapy（MNT） has become another important way to improve glycemic control and treat diabetes besides drugs. We reviewed and gave a summary of six nutritional strategies for glycemic control in patients with type 2 diabetes：choosing appropriate carbohydrate and eating the appropriate amount，eating specific types of dietary proteins，increasing the intake of polyunsaturated fatty acid，eating the Mediterranean diet，eating on time and strengthening postprandial exercise. These strategies may increase the options for healthcare professionals to choose for type 2 diabetics to achieve the optimal target glycemic level. Besides，our detailed analysis of the controversial aspects in the mechanisms of action of these strategies may provide a direction for further studies on nutritional therapies for type 2 diabetics.

Key words: Diabetes, type 2；Medical nutrition therapy；Dietary mode；Glycemic management

摘要： 医学营养治疗是除了药物之外又一控制血糖、治疗糖尿病的重要手段。目前控制2型糖尿病患者血糖水平的6种营养策略包括选择适量和合适的碳水化合物、食用特定的蛋白质、增加多不饱和脂肪酸摄入、采用地中海饮食模式、按时用餐及加强餐后运动。这一系列的营养策略为医疗保健专业人员提供选择，以帮助2型糖尿病患者达到血糖控制的最佳水平。本综述对这些策略进行介绍，并对其机制及研究中矛盾的地方进行分析和讨论，为2型糖尿病营养治疗的进一步研究提供方向。

关键词: 糖尿病, 2型；医学营养治疗；膳食模式；血糖管理

LI Haixia,LI Xiangpei,ZHAO Xiaodi, et al. Medical Nutrition Strategies in Glycemic Management in Patients with Type 2 Diabetes　[J]. Chinese General Practice, 2021, 24(13): 1702-1706. DOI: 10.12114/j.issn.1007-9572.2021.00.033.
李海霞,李向培,赵宵帝等. 2型糖尿病患者血糖管理中的医学营养策略[J]. 中国全科医学, 2021, 24(13): 1702-1706. DOI: 10.12114/j.issn.1007-9572.2021.00.033.

References

［1］American Diabetes Association．Diagnosis and classification of diabetes mellitus［J］．Diabetes Care，2014，37 suppl 1：s81-90．DOI：10.2337/dc14-S081.
［2］中华医学会糖尿病分会．中国2型糖尿病防治指南（2017年版）［J］．中国实用内科杂志，2018，38（4）：292-344．DOI：10.19538/j.nk2018040108.
［3］ALDWORTH J，PATTERSON C，JACOBS E．IDF diabetes atlas［M］．8th ed．Brussels：International Diabetes Federation，2017：8.
［4］ADU M D，MALABU U H，MALAU-ADULI A E O，et al．Enablers and barriers to effective diabetes self-management：a multi-national investigation［J］．PLoS One，2019，14（6）：e0217771．DOI：10.1371/journal.pone.0217771.
［5］CHOWDHURY T A，JACOB P．Challenges in the management of people with diabetes and cancer［J］．Diabete Med，2019，36（7）：795-802．DOI：10.1111/dme.13919.
［6］ABRAHAMIAN H，KAUTZKY-WILLER A，RIESSLAND-SEIFERT A，et al．Mental disorders and diabetes mellitus（update 2019）［J］．Wien Klin Wochenschr，2019，131（suppl 1）：186-195．DOI：10.1007/s00508-019-1458-9.
［7］HAMED A E，ELWAN N，NAGUIB M，et al．Diabetes association with liver diseases：an overview for clinicians［J］．Endocr Metab Immune Disord Drug Targets，2019，19（3）：274-280．DOI：10.2174/1871530318666181116111945.
［8］FRANZ M J，POWERS M A，LEONTOS C，et al．The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults［J］．J Am Diet Assoc，2010，110（12）：1852-1889．DOI：10.1016/j.jada.2010.09.014.
［9］EVERT A B，DENNISON M，GARDNER C D，et al．Nutrition therapy for adults with diabetes or prediabetes：a consensus report［J］．Diabetes Care，2019，42（5）：731-754．DOI：10.2337/dci19-0014.
［10］WHEELER M L，DUNBAR S A，JAACKS L M，et al．Macronutrients，food groups，and eating patterns in the management of diabetes：a systematic review of the literature，2010［J］．Diabetes Care，2012，35（2）：434-445．DOI：10.2337/dc11-2216.
［11］MA Y，OLENDZKI B C，MERRIAM H A，et al．A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes［J］．Nutrition，2008，24（1）：25-26．DOI：10.1016/j.nut.2007.10.008.
［12］BARNARD N D，COHEN J，JENKINS D J，et al．A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes［J］．Diabetes Care，2006，29（8）：1777-1783．DOI：10.2337/dc06-0606.
［13］中华医学会糖尿病学分会，中国医师协会营养医师专业委员会．中国糖尿病医学营养治疗指南（2013年版）［J］．中华糖尿病杂志，2015，7（2）：73-88．DOI：10.3969/j.issn.1672-7851.2016.07.002.
［14］MY B N，AT R，AK N，et al．Acute effect of low and high glycemic index meals on post-prandial glycemia and insulin responses in patients with type 2 diabetes mellitus［J］．Malays J Med Health Sci，2009，5（1）：11-20．DOI：10.1186/1475-2891-5-22.
［15］KAUR B，RANAWANA V，HENRY J．The glycemic index of rice and rice products：a review，and table of GI values［J］．Crit Rev Food Sci Nutr，2016，56（2）：215-236．DOI：10.1080/10408398.2012.717976.
［16］YAO B，FANG H，XU W，et al．Dietary fiber intake and risk of type 2 diabetes：a dose-response analysis of prospective studies［J］．Eur J Epidemiol，2014，29（2）：79-88．DOI：10.1007/s10654-013-9876-x.
［17］HOU Q，LI Y，LI L，et al．The metabolic effects of oats intake in patients with type 2 diabetes：a systematic review and meta-analysis［J］．Nutrients，2015，7（12）：10369-10387．DOI：10.3390/nu7125536.
［18］LI X，CAI X，MA X，et al．Short- and long-term effects of wholegrain oat intake on weight management and glucolipid metabolism in overweight type-2 diabetics：a randomized control trial［J］．Nutrients，2016，8（9）：549．DOI：10.3390/nu8090549.
［19］REYNOLDS A N，MANN J，ELBALSHY M，et al．Wholegrain particle size influences postprandial glycemia in type 2 diabetes：a randomized crossover study comparing four wholegrain breads［J］．Diabetes Care，2020，43（2）：476-479．DOI：10.2337/dc19-1466.
［20］FRANZ M J，MACLEOD J，EVERT A，et al．Academy of Nutrition and Dietetics Nutrition Practice Guideline for type 1 and type 2 diabetes in adults：systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process［J］．J Acad Nutr Diet，2017，117（10）：1659-1679．DOI：10.1016/j.jand.2017.03.022.
［21］VEGA-LOPEZ S，VENN B J，SLAVIN J L．Relevance of the glycemic index and glycemic load for body weight，diabetes，and cardiovascular disease［J］．Nutrients，2018，10（10）：1361．DOI：10.3390/nu10101361.
［22］PARK Y M，HEDEN T D，LIU Y，et al．A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes［J］．J Nutr，2015，145（3）：452-458．DOI：10.3945/jn.114.202549.
［23］LUGER M，HOLSTEIN B，SCHINDLER K，et al．Feasibility and efficacy of an isocaloric high-protein vs.standard diet on insulin requirement，body weight and metabolic parameters in patients with type 2 diabetes on insulin therapy［J］．Exp Clin Endocrinol Diabetes，2013，121（5）：286-294．DOI：10.1055/s-0033-1341472.
［24］DONG J Y，ZHANG Z L，WANG P Y，et al．Effects of high-protein diets on body weight，glycaemic control，blood lipids and blood pressure in type 2 diabetes：meta-analysis of randomised controlled trials［J］．Br J Nutr，2013，110（5）：781-789．DOI：10.1017/S0007114513002055.
［25］JAKUBOWICZ D，WAINSTEIN J，LANDAU Z，et al．High-energy breakfast based on whey protein reduces body weight，postprandial glycemia and HbA1c in type 2 diabetes［J］．J Nutr Biochem，2017，49：1-7．DOI：10.1016/j.jnutbio.2017.07.005.
［26］MA J，JESUDASON D R，STEVENS J E，et al．Sustained effects of a protein "preload" on glycaemia and gastric emptying over 4 weeks in patients with type 2 diabetes：a randomized clinical trial［J］．Diabetes Res Clin Pract，2015，108（2）：e31-34．DOI：10.1016/j.diabres.2015.02.019.
［27］JAKUBOWICZ D，FROY O，AHREN B，et al．Incretin，insulinotropic and glucose-lowering effects of whey protein pre-load in type 2 diabetes：a randomised clinical trial［J］．Diabetologia，2014，57（9）：1807-1811．DOI：10.1007/s00125-014-3305-x.
［28］SHUKLA A P，ANDONO J，TOUHAMY S H，et al．Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes［J］．BMJ Open Diabetes Res Care，2017，5（1）：e000440．DOI：10.1136/bmjdrc-2017-000440.
［29］MCGUIRE S．Scientific report of the 2015 dietary guidelines advisory committee．Washington，DC：US Departments of Agriculture and Health and Human Services，2015［J］．Adv Nutr，2016，7（1）：202-204．DOI：10.3945/an.115.011684.
［30］American Diabetes Association．Foundations of care and comprehensive medical evaluation［J］．Diabetes Care，2016，39 suppl 1：s23-35．DOI：10.2337/dc16-S006.
［31］DE SOUZA R J，MENTE A，MAROLEANU A，et al．Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality，cardiovascular disease，and type 2 diabetes：systematic review and meta-analysis of observational studies［J］．BMJ，2015，351：h3978．DOI：10.1136/bmj.h3978.
［32］ESTRUCH R，ROS E，SALAS-SALVADO J，et al．Primary prevention of cardiovascular disease with a Mediterranean diet［J］．N Engl J Med，2013，368（14）：1279-1290．DOI：10.1056/NEJMoa1200303.
［33］WU J H，MICHA R，IMAMURA F，et al．Omega-3 fatty acids and incident type 2 diabetes：a systematic review and meta-analysis［J］．Br J Nutr，2012，107 suppl 2：s214-227．DOI：10.1017/S0007114512001602.
［34］BROWN T J，BRAINARD J，SONG F，et al．Omega-3，omega-6，and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus：systematic review and meta-analysis of randomised controlled trials［J］．BMJ，2019，366：l4697．DOI：10.1136/bmj.l4697.
［35］DYSON P A，TWENEFOUR D，BREEN C，et al．Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes［J］．Diabet Med，2018，35（5）：541-547．DOI：10.1111/dme.13603.
［36］NEUENSCHWANDER M，BALLON A，WEBER K S，et al．Role of diet in type 2 diabetes incidence：umbrella review of meta-analyses of prospective observational studies［J］．BMJ，2019，366：l2368．DOI：10.1136/bmj.l2368.
［37］JIANG R，MANSON J E，STAMPFER M J，et al．Nut and peanut butter consumption and risk of type 2 diabetes in women［J］．JAMA，2002，288（20）：2554-2560．DOI：10.1001/jama.288.20.2554.
［38］CARTER P，GRAY L J，TROUGHTON J，et al．Fruit and vegetable intake and incidence of type 2 diabetes mellitus：systematic review and meta-analysis［J］．BMJ，2010，341：c4229．DOI：10.1136/bmj.c4229.
［39］EVERT A B，BOUCHER J L，CYPRESS M，et al．Nutrition therapy recommendations for the management of adults with diabetes［J］．Diabetes Care，2014，37 suppl 1：s120-143．DOI：10.2337/dc14-S120.
［40］MOZAFFARIAN D，APPEL L J，VAN HORN L．Components of a cardioprotective diet：new insights［J］．Circulation，2011，123（24）：2870-2891．DOI：10.1161/CIRCULATIONAHA.110.968735.
［41］AJALA O，ENGLISH P，PINKNEY J．Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes［J］．Am J Clin Nutr，2013，97（3）：505-516．DOI：10.3945/ajcn.112.042457.
［42］HUO R，DU T，XU Y，et al．Effects of Mediterranean-style diet on glycemic control，weight loss and cardiovascular risk factors among type 2 diabetes individuals：a meta-analysis［J］．Eur J Clin Nutr，2015，69（11）：1200-1208．DOI：10.1038/ejcn.2014.243.
［43］程改平，李舍予，胡雯．2018年《英国基于证据的预防管理糖尿病营养指南》解读［J］．中国全科医学，2018，21（17）：2017-2021．DOI：10.12114/j.issn.1007-9572.2018.00.011.
CHENG G P，LI S Y，HU W．The interpretation of 2018 diabetes UK evidence-based nutrition guideline for the prevention and management of diabetes［J］．Chinese General Practice，2018，21（17）：2017-2021．DOI：10.12114/j.issn.1007-9572.2018.00.011.
［44］MAI K．Mediterranean diet lowers diabetes risk［J］．MMW Fortschr Med，2014，156（10）：35.
［45］TIMLIN M T，PEREIRA M A．Breakfast frequency and quality in the etiology of adult obesity and chronic diseases［J］．Nutr Rev，2007，65（6 pt 1）：268-281．DOI：10.1301/nr.2007.jun.268-281.
［46］BI H，GAN Y，YANG C，et al．Breakfast skipping and the risk of type 2 diabetes：a meta-analysis of observational studies［J］．Public Health Nutr，2015，18（16）：3013-3019．DOI：10.1017/S1368980015000257.
［47］KNOWLER W C，BARRETT-CONNOR E，FOWLER S E，et al．Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin［J］．N Engl J Med，2002，346（6）：393-403．DOI：10.1056/NEJMoa012512.
［48］REYNOLDS A N，MANN J I，WILLIAMS S，et al．Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing：a randomised crossover study［J］．Diabetologia，2016，59（12）：2572-2578．DOI：10.1007/s00125-016-4085-2.
［49］AVERY A，GRIFFIN J，STOKES J，et al．The benefits of non-surgical weight management on weight and glycaemic control in people with complex type 2 diabetes：a primary care service evaluation of clinical outcomes at 12 months［J］．Endocrinol Diabetes Metab，2019，2（2）：e00045．DOI：10.1002/edm2.45.

[1]	WANG Yang, ZHAO Shiting, CHEN Yingying, SUN Zilin, QIU Shanhu. Key Points of Exercise Intervention and Implementation for People with Complications of Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(21): 2989-2994.
[2]	LI Jiawei, GAO Xinyi, GE Aoqi, LI Juanjuan, YUAN Beibei. Demand and Associated Factors for Integrated Medical Care and Preventive Services among Patients with Type 2 Diabetes [J]. Chinese General Practice, 2026, 29(21): 3028-3039.
[3]	PAN Ziyun, YIN Hao, LIN Zhirou, MAO Jingyi, HUANG Yan, LUO Yanhua, XIAO Jiafu, HU Yin. From Mechanism to Therapy: Diabetic Autonomic Neuropathy [J]. Chinese General Practice, 2026, 29(21): 2982-2988.
[4]	AN Yanhong, WANG Shidong, LI Xiaoran, GUO Jiayang, WANG Zhe, SHA Peilin, MENG Yijun, LI Xiaoxuan, SHI Xue, YU Zexing, XIAO Yonghua. Study on Risk Factors and Nomogram Prediction Model for Diabetic Kidney Disease: Based on Contrast-enhanced Ultrasound Technology [J]. Chinese General Practice, 2026, 29(21): 2995-3003.
[5]	GE Dan, WANG Zhi, DING Qun, GUO Tonglan, XU Tongdao. Relationship between Remnant Cholesterol and Non-alcoholic Fatty Liver Disease as well as Progressive Liver Fibrosis in Patients with Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(20): 2854-2859.
[6]	ZHANG Xiaojuan, LIU Yang, PENG Bo, YE Yuan, ZHU Kun. Study on the Prevention and Treatment of Hypertension and Diabetes Mellitus in Community Hospital [J]. Chinese General Practice, 2026, 29(19): 2614-2620.
[7]	JIAN Yingchun, ZENG Yongqin, ZHANG Haiping, WANG Zhengdi, AN Ke, YAN Rui. Recent Advances in Mitochondrial Dysfunction in Chronic Metabolic Diseases [J]. Chinese General Practice, 2026, 29(18): 2577-2584.
[8]	MIAO Jingjie, ZHANG Jinwen, WU Qianhao, HAN Peipei. Research Advances on the Effects of Intermittent Fasting on Cardiometabolic Diseases [J]. Chinese General Practice, 2026, 29(18): 2538-2545.
[9]	LI Yachan, YANG Yang, XU Qianting, KE Tingyu. Association between the Chinese Visceral Adiposity Index and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(18): 2482-2488.
[10]	LI Menglin, DING Fang, QIAN Yu, PU Dong, DU Qianqian, GUAN Tianhang, HE Yilin. Study on Glycemic Control Status and Influencing Factors among Community Diabetic Patients [J]. Chinese General Practice, 2026, 29(17): 2334-2339.
[11]	SUN Xibin, LI Jiawei, GE Aoqi, YUAN Beibei. The Association between the Specialists Outreach and the Job Perception and Diabetes Management Competence of Primary Care Providers [J]. Chinese General Practice, 2026, 29(17): 2319-2325.
[12]	CHEN Jiali, ZHANG Jingjing, WANG Hexia, TANG Xiaorui, WU Yujie, LEI Yang, LIN Zheng. Latent Profile Analysis of Chronic Illness Resource Utilization and Its Impact on Health-promoting Behaviors in Individuals with Prediabetes [J]. Chinese General Practice, 2026, 29(16): 2244-2251.
[13]	WANG Rui, LUO Dan, YANG Cuicui, WENG Xinyi, WANG Yubing, XU Jingjing. Complex Network Analysis of Resilience in Adolescents with Type 1 Diabetes Mellitus Based on Multi-sourced Stigma [J]. Chinese General Practice, 2026, 29(16): 2264-2272.
[14]	FU Mingyuan, YU Xiaoyi, GE Caiying, KONG Min. Impaired Awareness of Hypoglycemia: Prevalence and Determinants among Community-based Patients with Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(16): 2252-2258.
[15]	XU Ping, MA Yan, HUANG Li, HE Meiliang, HOU Yunfeng, WANG Dewang, SUN Panpan, LIU Zheng, GUO Yanfang, XU Ying. Association between Weight-adjusted Waist Index and Comorbidity of Hypertension, Diabetes and Dyslipidemia in Community-dwelling Adults [J]. Chinese General Practice, 2026, 29(16): 2198-2204.