M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Chennai, Tamil Nadu, India.
Wellness Clinic, Teynampet, Chennai, India.
Adv Ther. 2019 Mar;36(3):520-547. doi: 10.1007/s12325-019-0872-8. Epub 2019 Feb 7.
It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60-70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.
将注册营养师（RD）提供的医学营养疗法（MNT）整合到 2 型糖尿病（T2DM）的初级保健中至关重要。这对于实现改善整体代谢措施的目标是必要的，而不仅仅是限制卡路里和减轻体重。关于 T2DM 中营养的误解增加了在文化敏感人群中执行 MNT 的挑战。本综述基于证据和经验，提供了有关印度 T2DM 预防和管理中 MNT 的见解。它回顾了印度的历史研究，并提供了有关碳水化合物（60-70％）、蛋白质（~20％）和脂肪（10％）适当饮食摄入量的信息，这些信息在印度 T2DM 人群中是可接受和有益的。它讨论了碳水化合物和脂肪的细微差别，并解释了增加膳食纤维摄入、平衡低和高血糖指数食物的摄入以及用植物性多不饱和脂肪替代饱和脂肪与改善 T2DM 结局和减轻危险因素的关联。文章还讨论了患有合并症和疾病的特殊患者群体，以及他们在营养护理中需要进行的必要调整。它概述了 MNT 的逐步方法，涉及营养评估、诊断、个体化和患者咨询的精心配合。总的来说，MNT 的成功依赖于为持续的患者依从性提供准确、可接受和适当的饮食选择。需要糖尿病学家、内分泌学家、内科医生和 RD 之间的协作努力，以在印度的糖尿病实践中优先考虑和实施 MNT。资金：Signutra Inc.
