DM type 2
Nutritional Guidelines for Type 2 Diabetes Mellitus (T2DM)
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1. Lifestyle Modifications
1.1 Weight Management
Clinical Significance: Achieving a 5–10% weight loss reduces insulin resistance, improves
glycemic control, and lowers cardiovascular risk factors, including hypertension and
dyslipidemia.
This intervention is foundational in managing newly diagnosed T2DM patients and those at high
risk for progression.
1.2 Physical Activity
Clinical Significance: Regular physical activity (150 min/week of moderate-intensity aerobic
exercise + resistance training) improves insulin sensitivity, promotes weight loss, and reduces
HbA1c by up to 0.5–1.0%.
Exercise also supports cardiovascular health and reduces comorbidities like hypertension.
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2. Nutritional Therapy
2.1 General Dietary Patterns
Mediterranean Diet:
Clinical Significance: Rich in whole foods, healthy fats, and plant proteins, the Mediterranean
diet improves glycemic control, reduces inflammation, and lowers cardiovascular risks.
It is sustainable and effective for long-term adherence, leading to HbA1c reductions and weight
loss.
Plant-Based Diet:
Clinical Significance: A low-fat plant-based diet enhances insulin sensitivity, reduces HbA1c,
and supports weight loss, particularly when eliminating processed foods and emphasizing plant
protein.
2.2 Carbohydrate Management
Low-Glycemic-Index (GI) Foods:
Clinical Significance: Low-GI foods reduce postprandial glucose spikes and improve HbA1c
levels. These foods (e.g., oats, legumes, sweet potatoes) provide steady glucose release and
support better glycemic control.
Fiber-Rich Diets:
Clinical Significance: A high-fiber diet (25–30 g/day) enhances glycemic control, lowers
postprandial glucose, and supports weight management. Fiber delays glucose absorption,
reducing hyperglycemia.
Avoid Over-Restricting Carbs:
Clinical Significance: Excessive carbohydrate restriction may lead to nutrient deficiencies and
poor adherence. Balanced, unrefined carbohydrates are more sustainable and effective for
glycemic control.
2.3 Reduce Added Sugars and Refined Carbohydrates
Clinical Significance: Reducing added sugars and refined carbs lowers glycemic variability and
helps prevent weight gain. Water and naturally flavored beverages are effective replacements.
2.4 Macronutrient Distribution
Clinical Significance: Balanced macronutrient intake provides consistent energy, stabilizes
glucose levels, and supports metabolic health.
Carbs: 45–55%
Proteins: 15–20%
Fats: 20–35% (focus on unsaturated fats).
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3. Behavioral and Educational Support
Clinical Significance: Behavioral support and patient education improve adherence to dietary
and exercise plans, ultimately improving glycemic control and reducing complications.
Tailoring plans to patient preferences (e.g., cultural, religious, or socioeconomic factors)
increases long-term success.
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4. Alcohol Consumption
Clinical Significance:
Moderate alcohol intake (≤1 drink/day for women; ≤2 drinks/day for men) minimizes risks of
hyperglycemia and weight gain.
Educating patients about potential drug interactions (e.g., metformin, SGLT2 inhibitors) prevents
lactic acidosis or hypoglycemia.
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5. Vitamin and Mineral Supplementation
5.1 Vitamin B12
Clinical Significance:
Metformin and vegan diets increase the risk of vitamin B12 deficiency, leading to neuropathy,
cognitive decline, and anemia.
Annual monitoring and supplementation (100–200 µg/day or 500–1,000 µg 3–4 times weekly)
prevent complications.
5.2 Magnesium
Clinical Significance: Magnesium supports insulin action and reduces insulin resistance.
Including magnesium-rich foods improves metabolic function.
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6. Monitoring and Follow-Up
Clinical Significance: Regular follow-ups to assess HbA1c, nutrient levels, weight, and
adherence help identify gaps in care and ensure treatment goals are achieved.
Actionable Treatment Prescription for Type 2 Diabetes Mellitus (T2DM): A Practical Guide for
Nutritionists
Treatment Prescription
1. Weight Management
1. Set a Clear Weight Loss Target:
Aim for 5–10% body weight reduction over 6–12 months.
Individualize daily caloric goals:
Create a 500–750 kcal/day deficit based on current intake and activity levels.
2. Portion Control and Structured Eating:
Use the plate method:
Half the plate: Non-starchy vegetables (e.g., spinach, broccoli, zucchini).
One-quarter: Lean proteins (e.g., chicken, fish, tofu, legumes).
One-quarter: Whole grains or starchy vegetables (e.g., brown rice, quinoa, sweet potato).
3. Behavioral Support:
Promote mindful eating: Slow down, chew thoroughly, and avoid distractions during meals.
Encourage meal tracking using food journals or apps for accountability.
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2. Physical Activity Integration
1. Exercise Prescription:
Recommend 150 minutes/week of moderate-intensity aerobic activity:
Examples: Brisk walking, swimming, cycling.
Break it into 30-minute sessions, 5 times/week or smaller 10–15 minute bursts after meals.
Include 2–3 resistance training sessions/week:
Bodyweight exercises (squats, push-ups) or light weights.
2. Daily Movement Goals:
Encourage:
Taking stairs instead of elevators.
5–10 minute walks after meals to improve postprandial glucose.
Standing or stretching every 30–60 minutes when sitting for long periods.
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3. Carbohydrate Management
1. Focus on Low-Glycemic-Index (GI) Foods:
Prioritize foods that release glucose slowly:
Whole grains: Oats, barley, brown rice, quinoa.
Legumes: Lentils, chickpeas, black beans.
Fruits: Apples, pears, berries.
Vegetables: Sweet potatoes, leafy greens.
2. Distribute Carbohydrates Evenly:
Include moderate carbs at each meal (40–50% of calories/day).
Avoid large carb-heavy meals to minimize glucose spikes.
3. Avoid Refined Carbs and Added Sugars:
Limit sugary drinks (e.g., soda, juice) and processed snacks (e.g., cookies, white bread).
Replace with water, herbal teas, and whole food options.
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4. Fiber-Rich Diet
1. Increase Dietary Fiber to 25–30 g/day:
Include both soluble fiber and insoluble fiber:
Examples:
Legumes: Lentils, kidney beans.
Whole grains: Brown rice, quinoa, oats.
Vegetables: Broccoli, carrots, kale.
Fruits: Pears, apples, oranges.
2. Practical Implementation:
Add vegetables to every meal (e.g., salads, steamed greens).
Replace refined grains with whole grains (e.g., swap white rice for brown rice).
Incorporate beans and legumes into meals 3–4 times per week.
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5. Protein and Fat Recommendations
1. Prioritize Lean and Plant-Based Proteins:
Examples:
Skinless poultry, fish (2 servings/week), tofu, legumes, eggs, and low-fat dairy.
2. Include Healthy Fats:
Replace saturated fats (butter, fatty meats) with unsaturated fats:
Olive oil, avocado, nuts, seeds, and fatty fish (salmon, mackerel).
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6. Regular Meal Patterns
1. Avoid Skipping Meals:
Emphasize regular, structured eating with 3 balanced meals and 1–2 healthy snacks/day.
Discourage skipping breakfast to prevent overeating later and glucose spikes.
2. Plan Ahead:
Recommend meal prepping or planning a weekly grocery list to ensure healthy food availability.
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7. Vitamin and Mineral Support
1. Monitor Vitamin B12 Levels:
Patients on metformin or vegan diets require annual B12 testing.
Supplement with 100–200 µg/day or 500–1,000 µg/week as needed.
2. Encourage Magnesium-Rich Foods:
Sources: Spinach, almonds, black beans, and whole grains to improve insulin sensitivity.
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8. Alcohol Consumption
1. Set Limits for Alcohol:
Women: 1 drink/day; Men: 2 drinks/day.
Advise on risks of hypoglycemia and medication interactions (e.g., metformin, SGLT2 inhibitors).
2. Practical Tip:
Replace alcohol with sparkling water infused with fruits or herbs for a healthier alternative.
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9. Monitoring and Follow-Up
1. Set Regular Follow-Ups:
Track HbA1c, weight, nutrient levels (e.g., vitamin B12), and adherence to lifestyle changes.
Adjust meal plans and activity goals as needed based on progress.
2. Empower Patients:
Provide continuous education on reading food labels, portion control, and meal preparation
strategies.
Encourage small, sustainable changes rather than drastic restrictions.
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Complete References
1. Ley, S. H., Hamdy, O., Mohan, V., et al. (2014). Prevention and management of type 2
diabetes: dietary components and nutritional strategies. Lancet, 383(9933), 1999–2007.
PMID:24910231
2. Khemayanto, H., & Shi, B. (2014). Role of Mediterranean diet in prevention and management
of type 2 diabetes. Chin Med J (Engl), 127(20), 3651–3656. PMID:25316244
3. Chandalia, M., Garg, A., Lutjohann, D., et al. (2000). Beneficial effects of high dietary fiber
intake in patients with type 2 diabetes mellitus. N Engl J Med, 342(19), 1392–1398.
PMID:10805824
4. Chiavaroli, L., Lee, D., Ahmed, A., et al. (2021). Effect of low glycemic index or load dietary
patterns on glycemic control and cardiometabolic risk factors in diabetes. BMJ, 374, n1651.
PMID:34348965
5. Satija, A., Bhupathiraju, S. N., Rimm, E. B., et al. (2016). Plant-based dietary patterns and
incidence of type 2 diabetes in US men and women. PLOS Med, 13(6), e1002039.
PMID:27299701
6. Barbagallo, M., & Dominguez, L. J. (2015). Magnesium and type 2 diabetes. World J
Diabetes, 6(10), 1152–1157. PMID:26322160
7. Ajala, O., English, P., Pinkney, J. (2013). Systematic review and meta-analysis of different
dietary approaches to the management of type 2 diabetes. Am J Clin Nutr, 97(3), 505–516.
PMID:23364002
8. Sutton, E. F., Beyl, R., Early, K. S., et al. (2018). Early time-restricted feeding improves insulin
sensitivity, blood pressure, and oxidative stress even without weight loss. Cell Metab, 27(6),
1212–1221.e3. PMID:29754952
9. Evert, A. B., Dennison, M., Gardner, C. D., et al. (2019). Nutrition therapy for adults with
diabetes or prediabetes: A consensus report. Diabetes Care, 42(5), 731–754. PMID:31000505
إرشادات غذائية لمرضى السكري من النوع الثاني
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التحكم في الوزن.1
. من وزنك الحالي بشكل تدريجي لتحسين مستويات السكر في الدم%10–5 استهدف خسارة
.تناول وجبات متوازنة بكميات مناسبة وتجنب اإلفراط في الطعام
:استخدم طريقة الطبق الصحي
.) الخيار، البروكلي، خضروات غير نشوية (مثل السبانخ:نصف الطبق
.) العدس، الفول، الدجاج المشوي، بروتينات خفيفة (مثل السمك:ربع الطبق
.) البطاطا الحلوة، الشوفان، كربوهيدرات صحية (مثل األرز البني:ربع الطبق
.2ممارسة النشاط البدني
مارس الرياضة لمدة 150دقيقة أسبوعيًا (مثل المشي السريع ،ركوب الدراجة ،السباحة).
قم بتمارين تقوية العضالت 3–2مرات أسبوعيًا (مثل تمارين األوزان الخفيفة أو التمارين المنزلية).
تحرك بانتظام:
امش لمدة 10–5دقائق بعد كل وجبة لتحسين مستويات السكر.
ِ
تجنب الجلوس لفترات طويلة وانهض كل 60–30دقيقة للتحرك.
.3اختيار الكربوهيدرات الصحية
تناول أطعمة منخفضة المؤشر الجاليسيمي لتجنب ارتفاع السكر السريع:
الحبوب الكاملة :الشوفان ،األرز البني ،الكينوا.
البقوليات :العدس ،الفاصوليا ،الحمص.
الفواكه :التفاح ،التوت ،البرتقال.
الخضروات :البطاطا الحلوة ،البروكلي ،الخضروات الورقية.
.4زيادة تناول األلياف الغذائية
تناول 30–25جرامًا من األلياف يوميًا لتحسين الهضم والتحكم في مستويات السكر.
األطعمة الغنية باأللياف:
الحبوب الكاملة (مثل الشوفان ،الخبز األسمر).
الخضروات (مثل الجزر ،البروكلي).
الفواكه (مثل الكمثرى ،التفاح).
البقوليات (مثل العدس ،الفاصوليا).
.5تجنب السكريات المضافة والكربوهيدرات المكررة
قلل من تناول المشروبات المحالة (مثل المشروبات الغازية والعصائر المصنعة).
استبدلها بالماء أو الشاي باألعشاب أو المياه المنكهة طبيعيًا.
تجنب األطعمة المص ّنعة مثل الخبز األبيض والمعجنات والوجبات الخفيفة السكرية.
.6تناول البروتينات والدهون الصحية
اختر مصادر البروتين الصحية:
اللحوم البيضاء (الدجاج ،السمك) ،البيض ،والبقوليات.
تناول الدهون الصحية بداًل من الدهون المشبعة:
استخدم زيت الزيتون ،تناول األفوكادو ،المكسرات ،واألسماك الدهنية (مثل السلمون).
.7تنظيم مواعيد الوجبات
تناول 3وجبات رئيسية ووجبة أو وجبتين خفيفتين خالل اليوم.
تجنب تخطي وجبة اإلفطار لمنع حدوث ارتفاع مفاجئ في مستويات السكر الح ًقا.
.8االهتمام بالترطيب وتقليل الصوديوم
اشرب 8أكواب من الماء يوميًا.
قلل من تناول الملح واألطعمة المالحة لتجنب ارتفاع ضغط الدم.
.9المتابعة المستمرة
قم بقياس مستويات السكر بانتظام لتقييم استجابة جسمك للنظام الغذائي.
حافظ على زيارات دورية مع اختصاصي التغذية لضبط خطتك الغذائية حسب احتياجاتك وتطور حالتك.
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هذه اإلرشادات مصممة لتكون سهلة التطبيق وفعالة في تحسين إدارة مرض السكري من النوع الثاني والوقاية من مضاعفاته.
