Diet and diabetes, a brief overview: Personal perspective

Over the past several years there has been renewed interest in the dietary management of persons with diabetes. Many of the older concepts are being questioned and dietary recommendations are being revised. A uniform concensus regarding the best diet for insulin-requiring diabetic persons is not available. In my opinion, the best diet, considering our state of knowledge and the limitations imposed by current treatment modalities, is a diet that is most acceptable to the patient as long as it is nutritionally adequate. Once a diet is decided upon, constancy of carbohydrate (CHO) content for each meal is emphasized. A diet low in fat and containing approximately 50-60% CHO is desirable but is not as important as patient compliance. A stable reduction in the plasma glucose concentration in these patients should be the overwhelming objective. Dietary management of non-insulin requiring diabetic persons remains uncertain and controversial. Much more scientific data are needed before dietary recommendations can be made. Nevertheless, one can educate patients regarding CHO containing foods which have a large effect on the postmeal glucose concentration (cooked potatoes and cereal products such as bread and breakfast cereals) and those which produce a smaller effect (milk and milk products, fruits, vegetables, table sugar, and honey). With the interest in the dietary management of diabetic patients at the present time, I look forward to rapid progress in this field and resolution of the current controversies.