Diet, nutrition and type 2 diabetes: what is the evidence?
Diabetes is a metabolic disorder with the potential for multiple adverse health consequences.
It is also a public health challenge, with a rising global burden.
Estimates indicate that there were approximately 537 million people worldwide with diabetes in 2021,
which is projected to rise to 783 million by 2045, with type 2 diabetes constituting the majority (>90%) of this burden [1].
Diet and nutrition are of indisputable significance in reducing this burden because the development of type 2 diabetes is characterised by obesity and insulin resistance, leading to hyperglycaemia, and both weight and glycaemic control are directly related to food consumption.
Diet and nutrition are thus central as modifiable factors in both the management and the prevention of type 2 diabetes.
This is supported by three lines of evidence.
First, when adhered to, medical nutrition therapy in those with type 2 diabetes can match or exceed the glycaemic control that can be achieved by glucose-lowering medication in the short term, and can be useful in maintaining control [2]
Second, the proof of principle was established in the early 2000s that, among people with non-diabetic hyperglycaemia, the onset of type 2 diabetes can be delayed or prevented,
with as much as a 58% relative risk reduction, through a supported intensive lifestyle intervention including dietary changes and physical activity [3].
The real-world impact of lifestyle modification strategies has been demonstrated [4],
outside the highly controlled conditions of clinical trials,
and such a strategy has been found to be effective in the UK National Health Service (NHS) [5].
Third, it has been demonstrated that remission of type 2 diabetes can be achieved through dietary means [6], resulting in a major shift in scientific understanding of the pathophysiology of type 2 diabetes, from a condition previously thought to be progressive and irreversible to one that can be brought under control to normal functioning.
Reference
Diabetologia. 2023 Feb 14;66(5):786–799. doi: 10.1007/s00125-023-05873-z
Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes
Nita G Forouhi 1,✉
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