The Effects of Different Quantities and Qualities of Protein Intake in People with Diabetes Mellitus
Open accessAbstract
The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m2. Patients with a GFR <60 mL/min/1.73 m2 did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.
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Most meta-analyses were of critically low (n = 7) to low quality (n = 5).
“Most meta-analyses were of critically low (n = 7; [25–31]) to low quality (n = 5; [32–36]).”
Only one high-protein diet meta-analysis provided a definition of 'high protein' (>20% of energy intake), reporting significantly greater weight loss (−1.2 kg; 95% CI −2.17, −0.24; I2 = 5%, p = 0.38) than with lower-protein diets (<20% of energy from protein).
“Only one provided a definition of ‘high protein’ (>20% of energy intake), reporting significantly greater weight loss (−1.2 kg; 95% CI −2.17, −0.24; I2 = 5%, p = 0.38) than with lower-protein diets (<20% of energy from protein) [28].”
All meta-analyses (n = 3) of high-protein diets were of critically low quality.
“All meta-analyses (n = 3) of high-protein diets were of critically low quality [26, 28, 30].”
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Li, Y., Yu, L., Liu, Z., Jia, S., Man, Q., Zhu, Q., Li, C., Yang, Y., Liu, B., & Zhang, J. (2022) · Nutrients · doi:10.3390/nu15010056 · Cited by 5 · see citing works
Centner, M. G., Kenjeric, D. C., Schönberger, E., Centner, H., Rimac, D. S., Steiner, K., Marušić, R., Bakula, M., Vitković, D. F., Mihaljević, I., et al. (2024) · Life · doi:10.3390/life14091153 · Cited by 4 · see citing works
Schuppelius, B., Lalama, E., Zhang, J., Rüther, K. J. A., Csanalosi, M., Kabisch, S., Christ, A., Latz, E., Kraenkel, N., Pivovarova‐Ramich, O., et al. (2026) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2026.113159 · Cited by 5 · see citing works
Self-citationPlanting a path to kidney health: The vegetarian diet and diabetic nephropathy
Maqbool, M., Dar, M. A., & Ara, I. (2023) · Open Health · doi:10.1515/ohe-2023-0011 · Cited by 3 · see citing works
Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
Skurk, T., Bosy‐Westphal, A., Grünerbel, A., Kabisch, S., Keuthage, W., Kronsbein, P., Müssig, K., Nussbaumer, H., Pfeiffer, A. F. H., Simon, M., et al. (2024) · Diabetologie und Stoffwechsel · doi:10.1055/a-2312-0040 · Cited by 2 · see citing works
Self-citationBanaszak, M., Kosewski, G., Górna, I., & Drzymała-Czyż, S. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47121017 · Cited by 2 · see citing works
Ernährungsempfehlungen für Menschen mit Diabetes (Update 2023)
Klammer, C., Schindler, K., Bugl, R., Plazek, D., Vötter, M., Kirchner, T., Martino, C., Klammer-Martin, J., Brix, J. M., Dämon, S., et al. (2023) · Wiener klinische Wochenschrift · doi:10.1007/s00508-023-02170-y · Cited by 2 · see citing works
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Tabula, A., Bamuwamye, M., & Nakyinsige, K. (2024) · Discover Sustainability · doi:10.1007/s43621-024-00476-z · Cited by 2 · see citing works
Study on food nutrition and association with Diabetes Mellitus
Wan, S. (2020) · IOP Conference Series Earth and Environmental Science · doi:10.1088/1755-1315/615/1/012109 · Cited by 2 · see citing works
Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
Skurk, T., Bosy‐Westphal, A., Grünerbel, A., Kabisch, S., Keuthage, W., Kronsbein, P., Müssig, K., Nussbaumer, H., Pfeiffer, A. F. H., Simon, M., et al. (2022) · Diabetologie und Stoffwechsel · doi:10.1055/a-1886-3959 · Cited by 2 · see citing works
Self-citationEmpfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
Skurk, T., Bosy‐Westphal, A., Grünerbel, A., Kabisch, S., Keuthage, W., Kronsbein, P., Müssig, K., Nussbaumer, H., Pfeiffer, A. F. H., Simon, M., et al. (2023) · Diabetologie und Stoffwechsel · doi:10.1055/a-1997-7924 · Cited by 2 · see citing works
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Associations of diet with infectious diseases in UK Biobank
Tu, J., Cai, X., Wang, Y., Ye, X., Yu, M., Yang, S., Yu, R., & Huang, P. (2024) · Journal of Biomedical Research · doi:10.7555/jbr.37.20230319 · Cited by 1 · see citing works
Dilemmas in Elderly Diabetes and Clinical Practice Involving Traditional Chinese Medicine
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Self-citationNå kommer nye europeiske kostråd for diabetes
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You Are What You Eat: Preventive Roles of Antioxidant Phytochemicals on Age-related Eye Diseases
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Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
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Self-citationPlanetary Health Diet – geeignet für Menschen mit Typ-2-Diabetes?
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Nutritional Interventions in Diabetes Management
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Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
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Self-citationEmpfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
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Self-citationEmpfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus
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Self-citationErnährungsempfehlungen für Menschen mit Diabetes (Update 2026)
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Approaches for Individualizing the Diabetes Eating Plan
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- Authors
- Pfeiffer, A. F. H., Pedersen, E., Schwab, U., Risérus, U., Aas, A.-M., Uusitupa, M., Thanopoulou, A., Kendall, C., Sievenpiper, J. L., Kahleová, H., Rahélic, D., Salas-Salvadó, J., Gebauer, S., & Hermansen, K.
- Affiliations
- German Center for Diabetes Research (DE)
- University of South Australia (AU)
- University of Eastern Finland (FI)
- Uppsala University (SE)
- Oslo University Hospital (NO)
- National and Kapodistrian University of Athens (GR)
- St. Michael's Hospital (CA)
- Physicians Committee for Responsible Medicine (US)
- Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Merkur University Hospital, 10000 Zagreb, Croatia
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institute of Health Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
- Aarhus University Hospital (DK)
- Corresponding author
- Pfeiffer, Andreas F.H.
- ORCID
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2020-01-30
- Volume
- 12
- Issue
- 2
- Pages
- 365
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC7071151
- OpenAlex
- W3003309401
- Cited by
- 60
- References
- 55
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 15 · 2023: 12 · 2022: 11 · 2021: 7 · 2020: 3
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Rovira & Virgili repository (submittedVersion, cc-by)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
- Funders
- Novo Nordisk
- Diabetesliitto
- Diabetesforbundet
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- protein intake, diabetes mellitus, high-protein diet, weight loss diet, renal function, glomerular filtration rate, glycemic control, blood pressure, serum cholesterol, plant proteins, animal protein, dietary recommendations, quality of evidence
- MeSH terms
- Diet, High-Protein, Adult, Blood Pressure, Energy Intake, Diabetes Mellitus, Type 2, Dietary Proteins, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Middle Aged, Weight Loss, Diet, Protein-Restricted
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