Dietary carbohydrate (amount and type) in the prevention and management of diabetes - A statement by the American Diabetes Association

Regulation of blood glucose to achieve near-normal levels is a primary goal in the management of diabetes, and, thus, dietary techniques that limit hyperglycemia following a meal are likely important in limiting the complications of diabetes. Low-carbohydrate diets are not recommended in the management of diabetes. Although dietary carbohydrate is the major contributor to postprandial glucose concentration, it is an important source of energy, water-soluble vitamins and minerals, and fiber. Thus, in agreement with the National Academy of Sciences-Food and Nutrition Board, a recommended range of carbohydrate intake is 45-65% of total calories. In addition, because the brain and central nervous system have an absolute requirement for glucose as an energy source, restricting total carbohydrate to < 130 g/day is not recommended. Both the amount (grams) of carbohydrate as well as the type of carbohydrate in a food influence blood glucose level. The total amount of carbohydrate consumed is a strong predictor of glycemic response, and, thus, monitoring total grams of carbohydrate, whether by use of exchanges or carbohydrate counting, remains a key strategy in achieving glycemic control. A recent analysis of the randomized controlled trials that have examined the efficacy of the glycemic index on overall blood glucose control indicates that the use of this technique can provide an additional benefit over that observed when total carbohydrate is considered alone. Although this statement has focused primarily on the role of carbohydrate in the diet, the importance of achieving/ maintaining a healthy body weight (particularly in type 2 diabetes) in the management of diabetes should not be ignored. Moderate weight loss in overweight/obese individuals with type 2 diabetes results in improved control of hyperglycemia as well as in a reduction in risk factors for cardiovascular disease. Because much of the risk of developing type 2 diabetes is attributable to obesity, maintenance of a healthy body weight is strongly recommended as a means of preventing this disease. The relationship between glycemic index and glycemic load and the development of type 2 diabetes remains unclear at this time.