The goals of dietary advice are to achieve and maintain good health and quality of life, with avoidance and management of short-term symptoms, including hypoglycaemia and freedom from the long-term complications of the disease, for as long as possible. Evidence available from America from the Diabetes Control and Complications Trial in Type 1 diabetes and also from the United Kingdom Prospective Diabetes Study in Type 2 diabetes suggests that normalisation of metabolic markers like blood glucose levels and management of blood pressure constitute key aims. There needs to be a balance between the attainment of objectives of care and the demands that they may impose on the individual person with diabetes.
The recommendations should be adapted to an individual’s lifestyle, culture and socio-economic status. Personalised targets, based on the recommendations, need to be negotiated, clearly defined and communicated. There should be regular review and on-going dietary education.
The Practice Guidelines for Medical Nutrition Therapy developed in the USA for Type 1 diabetes have been shown to result in significant improvements in glycaemic control, and require more frequent and longer contacts between dietitians and patients. Patients from UKPDS, in centres with a greater availability of dietetic advice, lost more weight than those with less advice and also tended to have a greater decrease in plasma glucose, thus showing the need for more intensive care of diabetic patients.
