Quality of Carbohydrate and Diabetes Mellitus

Min Young Noh

doi:10.4093/jkd.2014.15.2.104

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Noh: Quality of Carbohydrate and Diabetes Mellitus

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J Korean Diabetes 2014;15(2):104-109.

Published online: 20 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.2.104

Quality of Carbohydrate and Diabetes Mellitus

Min Young Noh

Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The American Diabetes Association (ADA) revised the standards of care in diabetes patients in 2014. An important component of the revised guidelines is increased consideration of individual patient factors, with patient-specific recommendations about glycemic index/glycemic load, dietary fiber, sucrose, fructose etc. Education of diabetic patients needs to include information about the amount and quality of carbohydrate intake. It can be difficult to understand the factors affecting the quality of carbohydrate intake; therefore, we have to take into these factors into consideration when providing clinical nutrition education and assistance.

Keywords: Diabetes mellitus, Nutrition therapy, Carbohydrate, Quality

References

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Table 1.

Changes concerning the amount and quality of carbohydrate intake for adults with diabetes mellitus. A comparison of 2014 ADA nutrition recommendations with 2008 ADA nutrition recommendations [1,24]

Topic	Changes	2008 ADA nutrition recommendations	2014 ADA nutrition recommendations
Carbohydrates	Evidence rating down	Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation, remains a key strategy in achieving glycemic control [A]	Monitoring carbohydrate intake, whether by carbohydrate counting, or experienced based estimation remains a key strategy in achieving glycemic control [B]
Carbohydrates	Some changes	A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health [B]	For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium [B]
Glycemic index and glycemic load	Some changes & evidence rating down	The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone [B]	Substituting low-glycemic load foods for higher-glycemic load foods may modestly improve glycemic control [C]
Dietary fiber and whole grains	Some changes & evidence rating down	As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. However, evidence is lacking to recommend a higher fiber intake foe people with diabetes than the population as a whole [B]	People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public [C]
Sucrose	Some changes	Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake [A]	While substituting sucrose-containing foods for isocaloric amounts of other carbohydrates may have similar blood glucose effects, consumption should be minimized to avoid displacing nutrient-dense food choices [A]
Fructose	Added		Fructose consumed ad “free fructose”(i. e., naturally occurring in foods such as fruit) may result in better glycemic control compared with isocaloric intake of sucrose or starch [B]
			Free fructose is not likely to have detrimental effects on triglycerides as long as intake is not excessive (＞12% energy) [C]
			People with diabetes should limit or avoid intake of SSBs(from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk foe weight gain and worsening of cardiometabolic risk profile [B]
NNSs (nonnutritive sweeteners) and hypocaloric sweeteners	Some changes & evidence rating down	Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the FDA [A]	Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources [B]

The level of evidence that supports each recommendation is listed after the recommendation using the letters A, B, C, or E. A table linking recommendations to evidence can be reviewed at http://professional.diabetes.org/nutrition.

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