Q: I have a 50-year-old patient with diabetes who is trying to lose weight and decided to go on a low-carbohydrate diet. Is this recommended for patients with Type 2 diabetes?

Weight loss is a goal for many adults with diabetes. Although the evidence supports reducing energy intake to promote weight loss, there is no "best method" to achieve this goal. Important interventions to enhance weight loss efforts include self-weighing, eating breakfast, making healthy food choices, reducing portion sizes, regular physical activity, and frequent contact with a registered dietitian (Evert et al., 2014).

In patients with Type 2 diabetes, protein intake seems to increase insulin response without increasing overall glucose levels; carbohydrates, on the other hand, have a direct impact on blood glucose. However, the current evidence is inconclusive regarding the amount of carbohydrates needed for individuals with diabetes. What is known is that the balance between carbohydrate intake and available insulin may be the most important factor influencing glucose control. Therefore, individuals with diabetes should consider the impact of the amount and timing of carbohydrates when making food choices (Evert et al., 2014).

There are a variety of healthy eating options that are acceptable for the management of diabetes, including Mediterranean-style, vegetarian or vegan, lower-fat, and lower carbohydrate options. Studies indicate that the Mediterranean-style eating pattern as well as weight loss programs that include diet and exercise achieve the greatest weight lost, 6.2 kg and 8.4 kg, respectively; with improvements in A1C persisting for 12 months. The Mediterranean diet includes plant foods (beans, nuts, seeds, fruit, breads, and cereals), minimally processed foods, olive oil, and low/moderate amounts of dairy products. Red meat is not consumed very often and eggs are limited to four/week. Lower carbohydrate diets typically include foods that are higher in protein, fats, and vegetables. These types of diets may include fruit and higher carbohydrate vegetables, but grains like pasta, rice, and bread and sugar-containing foods are avoided. The amount of carbohydrates allowed varies by plan from very low to moderately low carbohydrate diet. Evaluating the effect of differing percentages of carbohydrates in people with diabetes has been inconclusive. But, evidence exists that supports the need to balance both the type of carbohydrate and quantity because of the influence on glycemic response (Evert et al., 2014).

It is important that patients receive education that focuses on the balance needed between nutrition and physical activity, as well as ongoing support to promote behavior change. Because diabetes is a disease that is mostly self-managed and because of the delicate balance needed to maintain glucose control, patients with diabetes should receive medical nutrition therapy from a registered dietitian. Another option is to attend a diabetes self-management education program that includes diabetes education and nutrition therapy. These providers have the knowledge and skills needed to help patients develop a meal plan that will meet their individual needs. Because the evidence suggests that there is not an "ideal" percentage of calories from carbohydrate, protein, and fat recommended for all individuals with diabetes, an individualized assessment is needed. This includes assessment of eating patterns and personal preferences that could be influenced by culture, religion, health beliefs, or even personal finances. Diabetes self-management education and medical nutrition therapy are often covered benefits under many health insurance plans.

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