Preventing diabetes in the clinical setting

Nutrition Counseling with and without Modules towards Nutrition Knowledge, Attitude, and Macronutrient Intake among Prediabetic Women

Prediabetes is one of risk factors for degenerative diseases. One of the prevention efforts is by improving the knowledge of nutrition and attitude through a counseling program. Modules are used as the media to convey the message of health with the form of words and pictures. The purpose of the study is to analyze the difference between the influence of nutrition counseling with the module and without the module, toward the raise of nutrition knowledge, attitudes, and the adequacy of macronutrients (energy, protein, fat, and carbohydrates) in prediabetic women. This study used a quasi-experimental method with pretest-posttest control group design. The sample consisted of 29 women ages between 35-50 with prediabetes who were divided into 2 groups: a treatment group provided with modules (n=15); and a control group with no modules provided (n=14). The counselling was done 4 times in 15-30 min duration each session. Paired t test and wilcoxon were used for within group, while independent t-test and Mann-Whitney were used between two groups. In treatment group, there was a significant increase score of pre-test and post-test of knowledge (p=0.01) by 16.16±21.56 and attitude (p=0.04) by 1.46±2.66. In control group, there was a notable increase score of pre-test and post-test of knowledge (p=0.02) by 10.71 ±15.39. There was no indicative difference in the improvement of knowledge score (p=0.443), score of attitude (p=0.783), energy intake (p=0.693), carbohydrates (p=0.585), protein (p=0.458), and fat (p=0.495) between the control group and the treatment group.

COVID-19 in People with Diabetes: Perspectives from Saudi Arabia

Coronavirus disease 2019 (COVID-19) and diabetes have major impacts on the health of the population across the world. Since the beginning of the COVID-19 pandemic, people with diabetes have been identified to be more vulnerable to infection and at greater risk for hospitalization. As diabetes is one of the major health issues in Saudi Arabia, the current study describes the perspectives of COVID-19 in people with diabetes and the steps taken by the government to minimize its impact. Most patients with COVID-19 in Saudi Arabia experience mild illness, while people with diabetes are at increased risk of disease severity and mortality. The government of Saudi Arabia has taken several measures to control and mitigate the effect of the pandemic, as the Saudi population is gradually returning back to normal life. However, currently, there are limited studies from Saudi Arabia on COVID-19 among people with diabetes and the effectiveness of interventions. We emphasize the necessity for comprehensive research, which would provide a better understanding of the incidence of COVID-19 and its association with diabetes to develop evidence- based programs and policies in the country.

Lifestyle and the Prevention of Type 2 Diabetes: A Status Report

Diabetes is a costly disease affecting 387 million individuals globally and 28 million in the United States. Its precursor, prediabetes, affects 316 and 86 million individuals globally and in the United States, respectively. People living with elevated blood glucose levels are at high risk for all-cause mortality and numerous cardiometabolic ailments. Fortunately, diabetes can be prevented or delayed by maintaining a healthy lifestyle and a healthy body weight. In this review, we summarize the literature around lifestyle diabetes prevention programs and provide recommendations for introducing prevention strategies in clinical practice. Overall, evidence supports the efficacy and effectiveness of lifestyle diabetes prevention interventions across clinical and community settings, delivery formats (eg, individual-, group-, or technology-based), and implementers (eg, clinicians, community members). Evidence-based diabetes prevention strategies that can be implemented in clinical practice include brief behavior change counseling, group-based education, community referrals, and health information technologies. These strategies represent opportunities where practitioners, communities, and health care systems can work together to provide individuals with education, support and opportunities to maintain healthy, diabetes-free lifestyles.

Nutrition Review: Diet and Nutrients in the Prevention and Treatment of Type 2 Diabetes

Lifestyle factors, including diet, are critical in the prevention and treatment of type 2 diabetes. Because weight gain increases diabetes risk, and even modest weight reduction reduces risk, weight management is paramount in lessening the occurrence and effects of diabetes. Weight loss interventions should include patient education, behavioral strategies, physical activity, energy intake deficits of 500 to 1000 kcal/day, and prevention of recidivism. Macronutrient distribution ranges of diets for diabetic patients follow those of the Dietary Reference Intakes, allowing for individualization according to a patient's metabolic responses, needs, and preferences. Nutrients to be limited include saturated fats, artificial trans fats, cholesterol, and sodium, whereas nutrients to be emphasized include monounsaturated fatty acids, omega-3 polyunsaturated fatty acids, fibers, antioxidants, and minerals, including potassium, magnesium, calcium, and chromium. Food sources are advised rather than supplements. Sugars can be isocalorically substituted for starches without detriments to glycemic control. Diets with low glycemic index or load may have modest benefits in managing type 2 diabetes. If a diabetic patient chooses to consume alcohol, he or she should do so in moderation. Foods advocated in type 2 diabetes are similar to those that are also beneficial in reducing risk for other chronic diseases.

Association between teaching and support skills and subjective effectiveness of nutritional guidance of registered dietitians at hospitals in a Japanese prefecture

OBJECTIVE

The aim of this study is to clarify the association between teaching and support skills and the subjective effectiveness of nutritional guidance of registered dietitians working at hospitals.

METHODS

We carried out a questionnaire survey of registered dietitians at hospitals in a Japanese prefecture. The utilization of nutritional teaching skills in nutritional guidance was investigated using a self-produced 36-item questionnaire that was designed to be mainly used for diabetic patients in 4 settings: first guidance, first assessment, contemplation stage, and preparation stage. The support skills were evaluated by Kikuchi's Scale of Social Skills: 18 items. The subjective effectiveness of nutritional guidance was defined by the behavioral change of the patients after nutritional guidance as evaluated by a registered dietitian.

RESULTS

There were 75 respondents (response rate 46.6 %). Among the teaching skills, basic skills in an interview were often used, but some related to coaching skills were not in common use in nutritional guidance. Based on the results of principal component analysis, we created a scale for scoring the utilization of nutritional teaching skills in each setting. Multiple linear regression analysis illustrated that high subjective effectiveness of nutritional guidance was associated with high score of teaching skills in the preparation stage setting and high score of support skills.

CONCLUSIONS

These results show that, in addition to frequent use of nutritional teaching skills, improvement of support skills is also necessary to enhance the effectiveness of nutritional guidance.

Combating Obesity at Community Health Centers (COACH): a quality improvement collaborative for weight management programs

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians' Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians' Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs.

Non-adherence to diet and exercise recommendations amongst patients with type 2 diabetes mellitus attending Extension II Clinic in Botswana

Background

Patients diagnosed with type 2 diabetes mellitus in Extension II Clinic in Botswana have difficulty in adhering to the lifestyle modifications recommended by health care practitioners. Poor adherence to lifestyle recommendations leads to poor control of the condition and consequently to complications.

Objectives

The aim of the study was to determine reasons for poor adherence to lifestyle recommendations amongst the patients. The objectives were to determine: reasons for poor adherence to dietary requirements, exercise recommendations, the support they had in adhering to the recommendations, and their understanding of the role of dietary and exercise requirements in the management of their condition.

Method

This was a cross-sectional descriptive study. The sample comprised of 105 participants. Data on participants’ baseline characteristics and adherence to dietary and exercise habits were analysed using the SPSS 14.0 version.

Results

The sample of 104 participants comprised of 61 (58.7%) women. The rates of non-adherence to diet and exercise were 37% and 52% respectively. The main reasons for non-adherence to diet were: poor self-discipline (63.4%); lack of information (33.3%) and the tendency to eat out (31.7%). The main reasons for non-adherence to exercise were: lack of information (65.7%); the perception that exercise exacerbated their illness (57.6%) and lack of an exercise partner (24.0%).

Conclusion

There was a relatively high rate of non-adherence to both diet and exercise recommendations by patients suffering from type 2 diabetes mellitus at Extension II Clinic, Botswana, with non-adherence to exercise recommendations more common.

Behavior matters

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social-environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.

Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis

Background

The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from randomised trials of structured, intensive interventions conducted in several countries over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes.

Methods

Data sources: MEDLINE (PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-language articles published from January 1990 to August 2009. The reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed. Study selection: We included RCTs, before/after evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence.

Results

Twelve from 41 potentially relevant studies were included in the review. Four studies were suitable for meta-analysis. A significant positive effect of the interventions on weight was reported by all study types. The meta-analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year. However, no clear effects on biochemical or clinical parameters were observed, possibly due to short follow-up periods or lack of power of the studies meta-analysed. Changes in dietary parameters or physical activity were generally not reported. Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care.

Conclusion

Lifestyle interventions for patients at high risk of diabetes, delivered by a variety of healthcare providers in routine clinical settings, are feasible but appear to be of limited clinical benefit one year after intervention. Despite convincing evidence from structured intensive trials, this systematic review showed that translation into routine practice has less effect on diabetes risk reduction.

Obesity stigma: a newly recognized barrier to comprehensive and effective type 2 diabetes management

PURPOSE

The purpose of this article is to increase awareness regarding the social problem of obesity stigma and its effects on persons with type 2 diabetes mellitus (T2DM). In addition, practical strategies to dispel stigma and improve diabetes care that nurse practitioners (NPs) can integrate into practice will be introduced.

DATA SOURCES

Thorough review of the literature was conducted including MEDLINE, PsycINFO and CINAHL, spanning the years 1994-2008.

CONCLUSIONS

Obesity and diabetes are both epidemics that demand immediate attention; however, obesity stigma can act as a barrier to ongoing management of both conditions. Obese patients with T2DM may feel responsible not only for their weight but also their diabetes. Therefore, NPs can employ specific counseling strategies that may be beneficial with T2DM obese patients to improve continuity of care while decreasing weight-related stigmatization.

IMPLICATIONS FOR PRACTICE

Negative attitudes toward obesity by healthcare professionals can act as a barrier to diabetes management. Primary care providers including NPs must begin through self-reflection to recognize their own attitudes regarding weight-stigma and how these attitudes may affect their patients. By implementing effective strategies to reduce weight bias, an environment conducive to diabetes and lifestyle modification management may prevent patients from forgoing care.

Type 2 Diabetes Risk Reduction in Overweight and Obese Adults Through Multidisciplinary Group Sessions: Effects of Meeting Attendance

This study evaluated the importance of attendance in a commercial weight loss program for type 2 diabetes risk reduction in normoglycemic men (n = 8) and women (n = 53) aged 25 to 50 years (38.7 ± 6.0 years), with a body mass index (BMI) of 27 to 35 kg/m2 (31.6 ± 2.3 kg/m2). The single-group 24-week intervention consisted of food, activity, and behavior modification plans within weekly meetings. Weight, waist circumference, meeting attendance, and glucose handling were measured before and after. Relationships between meeting attendance and outcomes were analyzed via Pearson correlation. Quartiles for meeting attendance were calculated (quartile 1: 30.0% ± 10.4%; quartile 2: 52.1% ± 5.8%; quartile 3: 65.5% ± 3.8%; quartile 4: 82.4% ± 4.6%), and between-group differences were assessed via 1-way analysis of variance. Meeting attendance was correlated with decreases in weight, BMI, and waist circumference (r = 0.476, 0.492, and 0.455; P = .002, .001, and .003, respectively). Quartile 1 lost significantly less weight than quartile 4 (—1.0 ± 3.5 kg vs —6.70 ± 3.58 kg). In quartiles 3 and 4, fasting insulin and HOMA-IR decreased (both P < .05), but not in quartiles 1 and 2. Fasting glucose decreased in all groups (P < .001), and glucose AUC decreased in quartiles 2, 3, and 4 (P < .001). Commercially available programs with weekly group meetings can be effective in reducing type 2 diabetes risk for overweight and obese adults, but attendance is critical.

Implementation and effectiveness of the first community lifestyle intervention programme to prevent Type 2 diabetes in Greece. The DE-PLAN study

AIMS

To report our experience of implementing the first community-based lifestyle intervention programme to detect high-risk individuals and prevent the development of Type 2 diabetes mellitus (T2DM) in a general population sample in Athens, Greece (the DE-PLAN Study).

METHODS

The Finnish Type 2 Diabetes Risk Score (FINDRISC) questionnaire was distributed to 7900 people at workplaces and primary-care centres. High-risk individuals were invited to receive an oral glucose tolerance test (OGTT) and, after excluding persons with diabetes, to participate in a 1-year intervention programme, based on bimonthly sessions with a dietitian.

RESULTS

Three thousand, two hundred and forty questionnaires were returned; 620 high-risk individuals were identified and 191 agreed to participate. Recruitment from workplaces was the most successful strategy for identifying high-risk persons, enrolling and maintaining them throughout the study. The 125 participants who fully completed the programme (66 did not return for a second OGTT) lost on average 1.0+/-4.7 kg (P=0.022). Higher adherence to the intervention sessions resulted in more significant weight loss (1.1+/-4.8 vs. 0.6+/-4.6 kg for low adherence). Persons with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at baseline lost more weight than those with normal glucose tolerance (1.5+/-4.8 vs. -0.2+/-4.5 kg). The percentage of people with any type of dysglycaemia (IFG/IGT) was lower after the intervention (68.0% at baseline vs. 53.6% 1 year later, P=0.009); 5.6% developed diabetes.

CONCLUSIONS

The implementation of a lifestyle intervention programme to prevent T2DM in the community is practical and feasible, accompanied by favourable lifestyle changes. Recruitment from workplaces was the most successful strategy.

Changes in racial/ethnic disparities in the prevalence of Type 2 diabetes by obesity level among US adults

OBJECTIVE

Ethnic minority status and obesity are two independent risk factors for Type 2 diabetes (T2D). There is no clear understanding of how they may have interacted and influenced disparities in T2D prevalence over time. This study examined the trends in racial/ethnic disparities in the prevalence of T2D by weight status among US adults.

METHODS

We used nationally representative data from the National Health and Nutrition Examination Surveys I (1971-1975), II (1976-1980), and III (1988-1994), and 1999-2004 among 49,574 adults aged 20-74 years. The prevalences of diagnosed and undiagnosed T2D were estimated by race/ethnicity groups (non-Hispanic White, non-Hispanic Black, and Mexican American) and body mass index (BMI) groups (normal, 18.5-24.9; overweight, 25-29.9; obese, 30-34.9; severely obese, >or=35). We used logistic regression controlling for age, gender, and education to estimate the odds ratio of T2D across race/ethnicity and BMI groups.

RESULTS

Trends in racial/ethnic disparities in prevalence of diagnosed T2D varied by BMI. Normal weight group saw increasing racial disparities. In the overweight group, ethnic disparities worsened as diabetes prevalence increased 33.3% in Whites, compared to 60.0% in Blacks, and 227.3% in Mexican Americans. Minimal racial/ethnic disparities were observed in obese and severely obese groups over time. In contrast to diagnosed diabetes, overall racial/ethnic disparities in undiagnosed T2D declined in all BMI groups.

CONCLUSIONS

Racial/ethnic disparities in diabetes prevalence have become most pronounced among normal and overweight groups. Eliminating racial/ethnic disparities in diabetes will require prevention efforts not only in obese minority individuals, but also in normal and overweight minority individuals.

Communicating with older diabetes patients: self-management and social comparison

OBJECTIVE

The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process.

METHODS

Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes.

RESULTS

Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care.

CONCLUSION

The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management.

PRACTICE IMPLICATIONS

Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices.

Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study

OBJECTIVE

To assess the effect of weight loss by bariatric surgery on the prevalence of the metabolic syndrome (MetS) and to examine predictors of MetS resolution.

PATIENTS AND METHODS

We performed a population-based, retrospective study of patients evaluated for bariatric surgery between January 1, 1990, and December 31, 2003, who had MetS as defined by the American Heart Association/National Heart, Lung, and Blood Institute (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased fasting glucose, and a measure of obesity). Of these patients, 180 underwent Roux-en-Y gastric bypass, and 157 were assessed in a weight-reduction program but did not undergo surgery. We determined the change in MetS prevalence and used logistic regression models to determine predictors of MetS resolution. Mean follow-up was 3.4 years.

RESULTS

In the surgical group, all MetS components improved, and medication use decreased. Nonsurgical patients showed improvements in high-density lipoprotein cholesterol levels. After bariatric surgery, the number of patients with MetS decreased from 156 (87%) of 180 patients to 53 (29%); of the 157 nonsurgical patients, MetS prevalence decreased from 133 patients (85%) to 117 (75%). A relative risk reduction of 0.59 (95% confidence interval [CI], 0.48-0.67; P<.001) was observed in patients who underwent bariatric surgery and had MetS at follow-up. The number needed to treat with surgery to resolve 1 case of MetS was 2.1. Results were similar after excluding patients with diabetes or cardiovascular disease or after using diagnostic criteria other than body mass index for MetS. Significant predictors of MetS resolution included a 5% loss in excess weight (odds ratio, 1.26; 95% CI, 1.19-1.34; P<.001) and diabetes mellitus (odds ratio, 0.32; 95% CI, 0.15-0.68; P=.003).

CONCLUSION

Roux-en-Y gastric bypass induces considerable and persistent improvement in MetS prevalence. Our results suggest that reversibility of MetS depends more on the amount of excess weight lost than on other parameters.

Opportunities and challenges for diabetes prevention at two community health centers

OBJECTIVE

Translating evidence-based diabetes prevention interventions to disadvantaged groups is a public health priority that poses unique challenges. Community health centers (CHCs) provide unequaled opportunities to prevent diabetes among poor and minority high-risk groups. This formative study sought to assess structural, processes-of-care (health care quality domains), and patient factors that need to be considered for diabetes prevention at CHCs.

RESEARCH DESIGN AND METHODS

A multimethod approach was implemented to assess system-, provider-, and patient-level factors at two large CHCs serving diverse urban communities.

RESULTS

Medical chart audits (n = 303) showed limited documentation of risks. Provider surveys (n = 74) evidenced knowledge gaps regarding factors associated with increased diabetes risk, efficacy of pharmacological interventions, and low perceived efficacy in promoting patient behavior change. Patient focus groups (two groups) with at-risk Hispanics and African Americans suggested mixed knowledge regarding whether diabetes can be prevented, some knowledge gaps regarding factors related to risk, and multiple challenges for lifestyle change.

CONCLUSIONS

Multiple and multilevel challenges to translating diabetes prevention interventions for the benefit of at-risk populations who seek care at CHCs were observed.

Meta-analysis of patient education interventions to increase physical activity among chronically ill adults

OBJECTIVE

This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses.

METHODS

Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses.

RESULTS

Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples.

CONCLUSION

These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect.

PRACTICE IMPLICATIONS

Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.

Nutrition Review: Diet and Nutrients in the Prevention and Treatment of Type 2 Diabetes

Lifestyle factors, including diet, are critical in the prevention and treatment of type 2 diabetes. Because weight gain increases diabetes risk, and even modest weight reduction reduces risk, weight management is paramount in lessening the occurrence and effects of diabetes. Weight loss interventions should include patient education, behavioral strategies, physical activity, energy intake deficits of 500 to 1000 kcal/day, and prevention of recidivism. Macronutrient distribution ranges of diets for diabetic patients follow those of the Dietary Reference Intakes, allowing for individualization according to a patient's metabolic responses, needs, and preferences. Nutrients to be limited include saturated fats, artificial trans fats, cholesterol, and sodium, whereas nutrients to be emphasized include monounsaturated fatty acids, omega-3 polyunsaturated fatty acids, fibers, antioxidants, and minerals, including potassium, magnesium, calcium, and chromium. Food sources are advised rather than supplements. Sugars can be isocalorically substituted for starches without detriments to glycemic control. Diets with low glycemic index or load may have modest benefits in managing type 2 diabetes. If a diabetic patient chooses to consume alcohol, he or she should do so in moderation. Foods advocated in type 2 diabetes are similar to those that are also beneficial in reducing risk for other chronic diseases.