because, of all the macronutrients, carbohydrates have the greatest effect on blood glucose and insulin levels. 86 It is important for children and adolescents to be physically active as well as following healthy eating guidelines to promote normal growth patterns, without exceeding recommended weight ranges for age and/or height. Due to the high risk of CVD (cardiovascular disease) in individuals diagnosed with diabetes, the goal for dietary fat intake (amount and type) for patients with diabetes is similar to that of patients with CVD but without diabetes. The idea of being on a diet for a chronic lifelong condition like diabetes is enough to put many people off as knowing what to eat and maintaining an optimal eating pattern are challenging.
Despite the nutrition transition being linked to an increasing prevalence of type 2 diabetes, obesity and other non-communicable diseases, strong measures to limit harmful foods are not in place in many countries. Secondly, evidence is increasing on the relevance of carbohydrate quality: that is that whole grains and fibre are better choices than refined grains and that fibre intake should be at least as high in people with type 2 diabetes as recommended for the general population. Further research in people with type 2 diabetes should help to clarify this. The quality of research that informs dietary guidelines also needs greater investment from the scientific community and funders. 44 However, other evidence highlights that worsening of treatable maculopathy or proliferative retinopathy may occur following a sudden fall in plasma glucose levels, 45 46 so retinal imaging in 4-6 months is recommended for individuals with more than minimal retinopathy if following a low calorie. Children AND adolescents While medical nutrition therapy provided by registered dietitians resulted in better glycemic control in children with newly diagnosed type 1 diabetes, a survey of 45 pediatric clinics revealed that only 25 clinics had a pediatric dietitian available for children with diabetes. This has led some experts to emphasise restricting refined starches and sugars but retaining whole grains. 24 Thirdly, the quality of the diet in low carbohydrate or low fat diets is important.
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