Mphasha Mabitsela Hezekiel, Vagiri Rajesh
Department of Public Health, University of Limpopo, Mankweng 0727, South Africa.
Department of Pharmacy, University of Limpopo, Mankweng 0727, South Africa.
Int J Mol Sci. 2025 Jan 13;26(2):624. doi: 10.3390/ijms26020624.
This narrative review examines the dynamic interplay between carbohydrate intake and diabetes medications, highlighting their combined molecular and clinical effects on glycemic control. Carbohydrates, a primary energy source, significantly influence postprandial glucose regulation and necessitate careful coordination with pharmacological therapies, including insulin, metformin, glucagon-like peptide (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Low-glycemic-index (GI) foods enhance insulin sensitivity, stabilize glycemic variability, and optimize medication efficacy, while high-GI foods exacerbate glycemic excursions and insulin resistance. Continuous glucose monitoring (CGM) offers real-time insights to tailor dietary and pharmacological interventions, improving glycemic outcomes and reducing complications. Despite advancements, gaps persist in understanding nutrient-drug interactions, particularly with emerging antidiabetic agents. This review underscores the need for integrating carbohydrate-focused dietary strategies with pharmacotherapy to enhance diabetes management. Future research should prioritize clinical trials leveraging CGM technology to explore how glycemic index, glycemic load, and carbohydrate quality interact with newer diabetes medications. Such studies can refine evidence-based recommendations, support individualized care plans, and improve long-term outcomes. Addressing systemic barriers, such as limited access to dietitians and CGM technology in underserved regions, is critical for equitable care. Expanding the roles of community health workers and training healthcare providers in basic nutrition counseling can bridge gaps, promoting sustainable and inclusive diabetes management strategies. These efforts are essential for advancing personalized, effective, and equitable care for individuals with diabetes.
这篇叙述性综述探讨了碳水化合物摄入量与糖尿病药物之间的动态相互作用，强调了它们对血糖控制的联合分子和临床影响。碳水化合物作为主要能量来源，对餐后血糖调节有显著影响，因此需要与包括胰岛素、二甲双胍、胰高血糖素样肽（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在内的药物治疗进行仔细协调。低血糖指数（GI）食物可提高胰岛素敏感性，稳定血糖变异性，并优化药物疗效，而高GI食物则会加剧血糖波动和胰岛素抵抗。持续葡萄糖监测（CGM）提供实时信息，以调整饮食和药物干预，改善血糖结果并减少并发症。尽管取得了进展，但在理解营养-药物相互作用方面仍存在差距，尤其是与新型抗糖尿病药物相关的相互作用。本综述强调了将以碳水化合物为重点的饮食策略与药物治疗相结合以加强糖尿病管理的必要性。未来的研究应优先开展利用CGM技术的临床试验，以探索血糖指数、血糖负荷和碳水化合物质量如何与新型糖尿病药物相互作用。此类研究可以完善基于证据的建议，支持个性化护理计划，并改善长期结果。解决系统性障碍，如在服务不足地区营养师和CGM技术获取有限的问题，对于公平护理至关重要。扩大社区卫生工作者的作用并培训医疗保健提供者进行基本营养咨询可以弥合差距，促进可持续和包容性的糖尿病管理策略。这些努力对于推进对糖尿病患者的个性化、有效和公平护理至关重要。
