Diyabetli Bireyler için Makro Besin Ögeleri Dağılım Oranları Ne Olmalı?

Tıbbi beslenme tedavisi, diyabet yönetiminin temel bileşenlerindendir. Kan glukozunu, kan yağlarını, kan basıncını hedef aralıkta tutmaya yardımcı olur, sağlıklı vücut ağırlığının sürdürülmesini sağlar, diyabete bağlı gelişebilecek akut ve kronik komplikasyon riskini azaltır. Uzun yıllardır diyabet tedavisi için ideal olan makro besin ögeleri oranları sorgulanmakta olup yapılan çalışmalar pek çok farklı beslenme müdahalesinin tedavide etkili olabileceğini göstermektedir. Ancak, bireyler eski beslenme alışkanlıklarına dönme eğiliminde olduklarından, uzun süreli, uygulanabilir bir beslenme modeli oluşturabilmek için, makro besin ögeleri oranına odaklanmaktan vazgeçilmelidir. Tedavi hedefleri bireye özgü değerlendirilmelidir. Diyabetlinin tercihlerine uygun, sürdürebileceği bir tıbbi beslenme tedavi planı oluşturulmalı, kanıta dayalı sınırlandırmalar yapılmalı, fakat yeme zevkinden mahrum edilmemelidir.

___

1. American Diabetes Association. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl. 1):S46-S60.

2. Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, et al. The Diabetes Care and Education Dietetic Practice Group. Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc. 1998;98:62-70.

3. Rossi MC, Nicolucci A, Di Bartolo P, Bruttomesso D, Girelli A, Ampudia FJ, et al. Diabetes Interactive Diary: a new telemedicine system enabling flexible diet and insulin therapy while improving quality of life: an open-label international, multicenter, randomized study. Diabetes Care. 2010;33:109-15.

4. Scavone G, Manto A, Pitocco D, Gagliardi L, Caputo S, Mancini L, et al. Effect of carbohydrate counting and medical nutritional therapy on glycaemic control in type 1 diabetic subjects: a pilot study. Diabet Med. 2010;27:477-9.

5. Franz MJ, MacLeod J, Evert A, Brown C, Gradwell E, Handu D, 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 Acad Nutr Diet. 2017;117:1659-79.

6. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854-65.

7. Ziemer DC, Berkowitz KJ, Panayioto RM, El-Kebbi IM, Musey VC, Anderson LA, et al. A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes. Diabetes Care. 2003;26:1719-24.

8. Wolf AM, Conaway MR, Crowther JQ, Hazen KYL, Nadler J, Oneiba B, et al. Improving Control with Activity and Nutrition (ICAN) Study. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. Diabetes Care. 2004;27:1570-6.

9. Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment–Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ. 2010;341:c3337.

10. Pastors JG, Franz MJ. Effectiveness of medical nutrition therapy in diabetes. In: Franz MJ, Evert AB, eds. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA: American Diabetes Association. 2012;1-18.

11. Franz MJ. Diabetes Nutrition Therapy: Effectiveness, macronutrients, eating patterns and weight management. Am J Med Sci. 2016;351(4):374-9.

12. Gannon MC, Nuttall FQ. Effect of a high-protein, low- carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004;53(9):2375-82.

13. Monnier L, Colette C. Postprandial and basal hyperglycaemia in type 2 diabetes: Contributions to overall glucose exposure and diabetic complications. Diabetes Metab. 2015;41(6 Suppl 1):6S9-15.

14. Diyabet Diyetisyenliği Derneği. Diyabetin Önlenmesi ve Tedavisinde Kanıta Dayalı Beslenme Tedavisi Rehberi-2019. İstanbul; 2019.

15. Hockaday TDR. Should the diabetic diet be based on carbohydrate of fat restriction? In Turner M, Thomas B, editors. Nutrition and diabetes. London: Libbey; 1981. p. 23-32.

16. Hamdy O, Barakatun-Nisak MY. Nutrition in diabetes. Endocrinol Metab Clin North Am. 2016;45:799-817.

17. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1-13.

18. Delahanty LM, Nathan DM, LachinJM, Hu FB, Cleary PA, Zieglar GK, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes. Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial. Am J Clin Nutr. 2009;89(2):518-24.

19. Xu J, Eilat-Adar S, Loria CM, Howard BW, Fabsitz RR, Beguum M, et al. Macronutrient intake and glycemic control in a population-based sample of American Indians with diabetes: the Strong Heart Study. Am J Clin Nutr. 2007;86:480-7.

20. Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, et al. Comparison of low- and high- carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015;102(4):780-90.

21. Koloverou E, Panagiotakos DB. Macronutrient Composition and Management of Non-insulin- dependent diabetes mellitus (NIDDM): A New paradigm for individualized nutritional therapy in diabetes patients. Rev Diabet Stud. 2016;13:6-16.

22. Boule ́ NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia. 2003;46:1071-81.

23. Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, et al. Look AHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366:1209-17.

24. Thomas DE, Elliott EJ. The use of low-glycaemic index diets in diabetes control. Br J Nutr. 2010;104:797-802.

25. Wheeler ML, Dunbar SA, Jaacks LM, KArmally W, Mayer-Davis EJ, Wylie-Rosett J, et al. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care. 2012;35:434-45.

26. Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev 2009;1:CD006296.

27. Evert AB, Boucher JL, Dunbar SA, Cypress M, Franz MJ, Mayer-Davis EJ, et al. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care 2014; 37 (Suppl 1): S120-43.

28. Silva FM, Kramer CK, de Almeida JC, Steemburgo T, Gross JL, Azevedo MJ. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr Rev. 2013;71:790-801.

29. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: Dietary components and nutritional strategies. Lancet. 2014;383:1999-2007.

30. Franz MJ, Boucher JL, Evert AB. Evidence-based diabetes nutrition therapy recommendations are effective: the key is individualization. Diabetes Metab Syndr and Obes. 2014;7:65-72.

31. Hamdy O, Ganda, O, Maryniuk M, Gabbay R. CHAPTER 2. Clinical nutrition guideline for overweight and obese adults with type 2 diabetes (T2D) or prediabetes, or those at high risk for developing T2D. The American journal of managed care.2018; 24. SP226-SP231.

32. Diabetes Canada Clinical Practice Guidelines Expert Committee, Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Nutrition Therapy. Can J Diabetes. 2018;42 Suppl 1:S64-S79.

33. He M, van Dam RM, Rimm E, Hu FB, Qi L. Whole grain, cereal fiber, bran, and germ intake and the risks of all-cause and CVD-specific mortality among women with type 2 diabetes. Circulation. 2010;121(20):2162-8.

34. Melanson KJ, Zukley L, Lowndes J, Nguyen V, Angelopoulos TJ, Rippe JM. Effects of high-fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and on appetite in normal-weight women. Nutrition. 2007;23:103-12.

35. Pan Y, Guo LL, Jin MJ. Low-protein diet for diabetic nephropathy: a meta- analysis of randomized controlled trials. Am J Clin Nutr. 2008;88:660-6.

36. Normand G, Lemoine S, Villien M, LEbars D, Merida İ, İrace Z, et al. AGE content of a protein load is responsible for renal performances: A Pilot Study Diabetes Care. 2018;41:1292-4.

37. Samkani A, Skytte MJ, KAndel D, Kjaer S, Astrup A, Deacon CF, et al. A carbohydrate-reduced high-protein diet acutely decreases postprandial and diurnal glucose excursions in type 2 diabetes patients. Br J Nutr. 2018;119:910-7.

38. Brehm BJ, Lattin BL, Summer SS, Boback JA, Gilchrist GM, Jandacek RJ, et al. One-year comparison of a high–monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes. Diabetes Care. 2009;32:215-20.

39. McEwen B, Morel-Kopp MC, Tofler G, Ward C Effect of omega-3 fish oil on cardiovascular risk in diabetes. Diabetes Educ. 2010;36:565-84.

40. Elhayany A, Lustman A, Abel R, Attal-Singer J Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010;12:204-9.