Evidence-based European recommendations for the dietary management of diabetes
Open accessAbstract
Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.
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Clinical guidelines have begun to recommend remission of type 2 diabetes as a key management target with interventions that incorporate the DiRECT Principles, using evidence-based recommendations for weight management.
“Clinical guidelines have begun to recommend remission of type 2 diabetes as a key management target with interventions that incorporate the DiRECT Principles, 12 using evidencebased recommendations for weight management. 13”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [12]
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- Authors
- The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Aas, A.-M., Axelsen, M., Churuangsuk, C., Hermansen, K., Kendall, C. W. C., Kahleova, H., Khan, T., Lean, M. E. J., Mann, J. I., Pedersen, E., Pfeiffer, A., Rahelić, D., Reynolds, A. N., Risérus, U., Rivellese, A. A., Salas-Salvadó, J., Schwab, U., Sievenpiper, J. L., Thanopoulou, A., & Uusitupa, E. M.
- Affiliations
- University of Toronto (CA)
- ORCID
- Venue
- Diabetologia
- Published
- 2023-04-17
- Volume
- 66
- Issue
- 6
- Pages
- 965-985
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W4366228237
- Cited by
- 262
- References
- 188
- Citations by year
- 2026: 71 · 2025: 100 · 2024: 64 · 2023: 27
- FWCI
- 67.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Agriculture
- Amgen
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- PepsiCo
- World Health Organization
- General Mills
- Itä-Suomen Yliopisto
- Danone
- Almond Board of California
- Institut d'Investigació Sanitària Pere Virgili
- Dairy Farmers of Canada
- Diabetes-Stiftung
- United Soybean Board
- Canadian Cardiovascular Society
- Diabetes Canada
- Canola Council of Canada
- Alberta Pulse Growers Commission
- Loblaw Companies Limited
- Peanut Institute
- Physicians Committee for Responsible Medicine
- Soy Nutrition Institute
- National Honey Board
- Institute for the Advancement of Food and Nutrition Sciences
- National Institute for Health and Care Research
- Diabetes UK
- University of Glasgow
- Commonwealth Scientific and Industrial Research Organisation
- European Foundation for the Study of Diabetes
- Agence Nationale de la Recherche
- University of Adelaide
- University of South Australia
- Svenska Forskningsrådet Formas
- Generalitat de Catalunya
- University of Toronto
- Institució Catalana de Recerca i Estudis Avançats
- Novo Nordisk
- Vetenskapsrådet
- National and Kapodistrian University of Athens
- Uppsala Universitet
- Universitat Rovira i Virgili
- European Association for the Study of Diabetes
- Diabetesliitto
- Diabetesforbundet
- Instituto Danone
- International Nut and Dried Fruit Council
- International Sweeteners Association
- Canadian Institutes of Health Research
- Agriculture and Agri-Food Canada
- Agència de Gestió d'Ajuts Universitaris i de Recerca
- Instituto de Salud Carlos III
- Strategic Research Council
- Obesity Canada
- Ontario Ministry of Research and Innovation
- Institute of Nutrition, Metabolism and Diabetes
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes prevention, type 2 diabetes remission, dietary habits, whole grains, vegetable oils, red and processed meat, sodium intake, sugar-sweetened beverages, refined grains, food processing, patient support, health-related quality of life, glycemic control, GRADE certainty of evidence
- MeSH terms
- Diabetes Mellitus, Type 2, Diet, Fruit, Humans, Meat, Quality of Life, Vegetables
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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