Cover
Title Page
Preface
Foreword
Editor biographies
Contributors
Abbreviations
SECTION 1: Background
1. Chapter 1.1: Prevalence, public health aspects and prevention of diabetes
  1. 1.1.1 Prevalence
  2. 1.1.2 Pre-diabetes
  3. 1.1.3 Public health aspects
  4. 1.1.4 Prevention
  5. References
2. Chapter 1.2: Diagnostic criteria and classification of diabetes
  1. 1.2.1 Diagnostic criteria
  2. 1.2.2 Classification
  3. References
SECTION 2: Dietary principles of diabetes
1. Chapter 2.1: Historical perspectives of dietary recommendations for diabetes
  1. 2.1.1 From early times to the seventeenthth century
  2. 2.1.2 Eighteenth and nineteenth centuries
  3. 2.1.3 Twentieth century
  4. 2.1.4 Dietary management of type 2 diabetes
  5. 2.1.5 Carbohydrate counting and exchanges
  6. 2.1.6 Glycaemic index
  7. 2.1.7 Development of nutritional guidelines for diabetes
  8. 2.1.8 Guidelines for low and middle income ountries
  9. 2.1.9 Guidelines for children and adolescents
  10. 2.1.10 A change in emphasis
  11. 2.1.11 Summary
  12. References
2. Chapter 2.2: Nutritional guidelines for diabetes
  1. 2.2.1 Effectiveness of diabetes nutrition therapy
  2. 2.2.2 Diabetes nutrition therapy and macronutrients
  3. 2.2.3 Conclusion
  4. References
3. Chapter 2.3: Carbohydrates
  1. 2.3.1 Introduction
  2. 2.3.2 Adverse effects of fructose: potential metabolic pathways
  3. 2.3.3 Contributors to the adverse effects of fructose
  4. 2.3.4 Conclusion
  5. References
4. Chapter 2.4: Glycaemic index and glycaemic load in diabetes
  1. 2.4.1 Introduction
  2. 2.4.2 Measurement of glycaemic index and glycaemic load
  3. 2.4.3 Factors affecting glycaemic index and glycaemic load
  4. 2.4.4 GI, GL and diabetes
  5. 2.4.5 GI, GL and obesity
  6. 2.4.6 Metabolic effects of low glycaemic index and glycaemic load diets
  7. 2.4.7 GI and GL in real life situations
  8. 2.4.8 Conclusion
  9. References
SECTION 3: Type 1 diabetes
1. Chapter 3.1: Epidemiology and pathogenesis of type 1 diabetes
  1. 3.1.1 Epidemiology
  2. 3.1.2 Pathogenesis of type 1 diabetes
  3. 3.1.3 Environmental Triggers
  4. 3.1.4 Summary
  5. References
2. Chapter 3.2: Clinical management of type 1 diabetes
  1. 3.2.1 Introduction
  2. 3.2.2 Clinical presentation
  3. 3.2.3 Medical management of hyperglycaemia
  4. 3.2.4 Cardiovascular risk and type 1 diabetes
  5. 3.2.5 Hypoglycaemia
  6. 3.2.6 Conclusion
  7. References
3. Chapter 3.3: Nutritional management of glycaemia in type 1 diabetes
  1. 3.3.1 Introduction
  2. 3.3.2 Nutrition and glucose management – the evidence
  3. References
4. Chapter 3.4: Diet, education and behaviour in type 1 diabetes
  1. 3.4.1 Introduction
  2. 3.4.2 Education
  3. 3.4.3 Summary
  4. References
5. Chapter 3.5: Lifestyle issues and type 1 diabetes – physical activity, alcohol and recreational drugs
  1. 3.5.1 Introduction
  2. 3.5.2 Physical activity
  3. 3.5.3 Alcohol
  4. 3.5.4 Recreational and prescription drug use
  5. References
  6. Useful websites
SECTION 4: Type 2 diabetes
1. Chapter 4.1: Epidemiology, aetiology and pathogenesis of type 2 diabetes
  1. 4.1.1 Epidemiology
  2. 4.1.2 Aetiology and pathogenesis
  3. 4.1.3 Conclusion
  4. References
2. Chapter 4.2: Clinical management of hyperglycaemia in type 2 diabetes
  1. 4.2.1 Introduction
  2. 4.2.2 Multiple-risk-factor approach to treatment
  3. 4.2.3 Treatment of hyperglycaemia
  4. 4.2.4 Implementation strategies
  5. 4.2.5 Hypoglycaemia
  6. 4.2.6 Conclusions
  7. References
3. Chapter 4.3: Nutritional management of glycaemia in Type 2 diabetes
  1. 4.3.1 Introduction
  2. 4.3.2 Weight management and glycaemic control
  3. 4.3.3 Macronutrients and glycaemic control
  4. 4.3.4 Carbohydrate and glycaemic control
  5. 4.3.5 Fat and glycaemic control
  6. 4.3.6 Protein and glycaemic control
  7. 4.3.7 Foods versus nutrients
  8. 4.3.8 Conclusions
  9. References
4. Chapter 4.4: Obesity and cardiovascular risk in type 2 diabetes
  1. 4.4.1 Introduction
  2. 4.4.2 Structural changes to the heart in obesity
  3. 4.4.3 Obesity and dysrhythmias
  4. 4.4.4 Obesity and hypertension
  5. 4.4.5 Obesity and dyslipidemia
  6. 4.4.6 Obesity insulin resistance and inflammation
  7. 4.4.7 Effects of weight loss on CV risk
  8. 4.4.8 Obesity paradox
  9. 4.4.9 What is the best dietary composition for the prevention of CVD?
  10. 4.4.10 Mediterranean diet
  11. 4.4.11 Summary
  12. References
5. Chapter 4.5: Diet, education and behaviour in type 2 diabetes
  1. 4.5.1 Diet and behaviour education
  2. 4.5.2 One-to-one education
  3. 4.5.3 Group-based education
  4. 4.5.4 Interventions that support behaviour change
  5. 4.5.5 Resources that support behaviour change
  6. 4.5.6 Healthcare professional communication skills that support behaviour change
  7. References
6. Chapter 4.6: Lifestyle issues and type 2 diabetes – physical activity and alcohol
  1. 4.6.1 Introduction
  2. 4.6.2 Physical activity
  3. 4.6.3 Alcohol
  4. References
7. Chapter 4.7: Public health and the prevention of type 2 diabetes
  1. 4.7.1 Risk factors for type 2 diabetes
  2. 4.7.2 Screening for type 2 diabetes
  3. 4.7.3 Diabetes prevention
  4. References
SECTION 5: Pregnancy and diabetes
1. Chapter 5.1: Epidemiology, aetiology and pathogenesis of diabetes in pregnancy
  1. 5.1.1 Introduction
  2. 5.1.2 Epidemiology
  3. 5.1.3 Aetiology
  4. 5.1.4 Risk factors
  5. References
2. Chapter 5.2: Clinical management of diabetes in pregnancy
  1. 5.2.1 Introduction
  2. 5.2.2 Pre-conception care
  3. 5.2.3 Antenatal care
  4. 5.2.4 Perinatal care
  5. 5.2.5 Postnatal care
  6. 5.2.6 Screening for diabetes in pregnancy
  7. 5.2.7 Conclusion
  8. References
3. Chapter 5.3: Lifestyle management of diabetes in pregnancy
  1. 5.3.1 Introduction
  2. 5.3.2 Pre-pregnancy
  3. 5.3.3 Obesity
  4. 5.3.4 Nutritional management of diabetes in pregnancy
  5. 5.3.5 Physical activity
  6. 5.3.6 Lactation
  7. 5.3.7 Summary
  8. References
SECTION 6: Diabetes in children and adolescents
1. Chapter 6.1: Epidemiology, aetiology and pathogenesis of childhood diabetes
  1. 6.1.1 Introduction
  2. 6.1.2 Epidemiology of childhood diabetes
  3. 6.1.3 Aetiology, classification and pathogenesis
  4. 6.1.4 Pathogenesis of diabetes in childhood
  5. 6.1.5 Conclusion
  6. References
2. Chapter 6.2: Clinical management of diabetes in children and adolescents
  1. 6.2.1 Introduction
  2. 6.2.2 Insulin management
  3. 6.2.3 Diabetes emergencies
  4. 6.2.4 Insulin pump therapy
  5. 6.2.5 Type 2 diabetes
  6. References
3. Chapter 6.3: Lifestyle management of childhood diabetes
  1. 6.3.1 Introduction
  2. 6.3.2 Type 1 diabetes
  3. 6.3.3 Type 2 diabetes
  4. 6.3.4 Summary
  5. References
SECTION 7: Diabetes in older people
1. Chapter 7.1: Epidemiology, aetiology, pathogenesis and management of diabetes in older people
  1. 7.1.1 Introduction
  2. 7.1.2 Epidemiology
  3. 7.1.3 Incidence and prevalence
  4. 7.1.4 Aetiology and pathogenesis
  5. 7.1.5 Risk factors
  6. 7.1.6 Screening
  7. 7.1.7 Prevention
  8. 7.1.8 Conclusion
  9. References
2. Chapter 7.2: Lifestyle management, including nutrition, of diabetes in older people
  1. 7.2.1 Introduction
  2. 7.2.2 Brief overview of the pathogenesis of diabetes in older people
  3. 7.2.3 Clinical features of diabetes in older people
  4. 7.2.4 Overview of management strategies
  5. 7.2.5 Management guidelines
  6. 7.2.6 General health care
  7. 7.2.7 Blood glucose monitoring and blood glucose targets
  8. 7.2.8 Nutrition and activity
  9. 7.2.9 Medicines: the need for pharmacovigilance
  10. 7.2.10 Surgical care
  11. 7.2.11 Annual health assessment
  12. 7.2.12 Summary
  13. References
SECTION 8: Diabetes in ethnic groups
1. Chapter 8.1: Epidemiology, aetiology and pathogenesis of diabetes in ethnic groups
  1. 8.1.1 Introduction
  2. 8.1.2 Epidemiology
  3. 8.1.3 Aetiology
  4. 8.1.4 Pathogenesis
  5. 8.1.5 Conclusion
  6. References
2. Chapter 8.2: Clinical management of diabetes in ethnic groups
  1. 8.2.1 Introduction
  2. 8.2.2 Classification and atypical presentation
  3. 8.2.3 Assessing glycaemic control
  4. 8.2.4 Glycaemic control management
  5. 8.2.5 Clinical management of complications
  6. 8.2.6 Summary
  7. References
3. Chapter 8.3: Lifestyle management of diabetes in ethnic groups
  1. 8.3.1 Introduction
  2. 8.3.2 Nutritional considerations in ethnic groups
  3. 8.3.3 Cultural barriers to lifestyle modifications
  4. 8.3.4 Designing lifestyle interventions for ethnic minority groups
  5. 8.3.5 Culturally tailored care in practice
  6. 8.3.6 Recommendations for future research, policy and practice
  7. 8.3.7 Conclusion
  8. References
SECTION 9: Complications and comorbidities of diabetes
1. Chapter 9.1: Microvascular disease (renal) and diabetes
  1. 9.1.1 Introduction
  2. 9.1.2 Early diabetic CKD (stages 1–3) management
  3. 9.1.3 Nutritional requirements
  4. 9.1.4 Nutritional assessment
  5. 9.1.5 Late diabetic CKD (stages 4–5) management
  6. 9.1.6 Future developments
  7. References
2. Chapter 9.2: Macrovascular disease and diabetes
  1. 9.2.1 Epidemiology of macrovascular disease in diabetes
  2. 9.2.2 Effects of intervention on glycaemic control
  3. 9.2.3 Effects of intervention on other cardiovascular risk factors
  4. 9.2.4 Conclusions
  5. References
3. Chapter 9.3: Coeliac disease and diabetes
  1. 9.3.1 Introduction
  2. 9.3.2 Clinical onset and symptoms
  3. 9.3.3 Diagnosis
  4. 9.3.4 Treatment of coeliac disease
  5. 9.3.5 Dietary sources of gluten
  6. 9.3.6 Diet in diabetes
  7. References
4. Chapter 9.4: Disorders associated with insulin resistance
  1. 9.4.1 Introduction
  2. 9.4.2 Polycystic ovary syndrome
  3. 9.4.3 Non-alcoholic fatty liver disease
  4. 9.4.4 HIV
  5. References
  6. Recommended website
5. Chapter 9.5: Cystic fibrosis-related diabetes
  1. 9.5.1 Introduction
  2. 9.5.2 Epidemiology of CFRD
  3. 9.5.3 Pathophysiology of CFRD
  4. 9.5.4 Screening
  5. 9.5.5 Diagnosis
  6. 9.5.6 Clinical consequences of CFRD
  7. 9.5.7 Management of CFRD
  8. 9.5.8 Conclusion
  9. 9.5.9 Unanswered questions
  10. References
6. Chapter 9.6: Diabetic gastroparesis
  1. 9.6.1 Introduction
  2. 9.6.2 Prevalence
  3. 9.6.3 Risk factors for DGP
  4. 9.6.4 Diagnosis
  5. 9.6.5 Effects of DGP
  6. 9.6.6 Treatment of DPG
  7. 9.6.7 Glycaemic control
  8. 9.6.8 Dietary treatment
  9. References
7. Chapter 9.7: Nutrition support in diabetes
  1. 9.7.1 Introduction
  2. 9.7.2 Standards of care
  3. 9.7.3 Oral nutrition support
  4. 9.7.4 Enteral nutrition
  5. 9.7.5 Medication changes
  6. 9.7.6 Total parenteral nutrition
  7. 9.7.7 Discharge from hospital
  8. 9.7.8 Conclusion
  9. References
  10. Further reading
Index
End User License Agreement

List of Tables

Chapter 1.1
1. Table 1.1.1 Regional estimates for diabetes (20–79 age group), 2010 and 2030
Chapter 2.1
1. Table 2.1.1 Historical changes in the nutritional management of diabetes (Sanders, 2001 [4]; Canadian Diabetic Association, 2008 ADA, 2008 [16]; Diabetes UK, 2011 [18]; Tattersall, 2009 [2])
Chapter 2.4
1. Table 2.4.1 Glycaemic index and glycaemic load classification
2. Table 2.4.2 Comparison of the glycaemic index and glycaemic load of some common foods
3. Table 2.4.3 Practical application of the glycaemic index – low, medium and high GI foods
Chapter 3.2
1. Table 3.2.1 ADA and AACE guidelines for target HbA1c.
2. Table 3.2.2 Characteristics of insulin for treating type 1 diabetes.
Chapter 3.3
1. Table 3.3.1 Summary of key recommendations for carbohydrate management in type 1 diabetes
Chapter 3.5
1. Table 3.5.1 Restrictions on sports for people with type 1 diabetes [2]
2. Table 3.5.2 Blood glucose response and circulating insulin levels
3. Table 3.5.3 Activity type and implications for type 1 diabetes [7]
4. Table 3.5.4 General exercise guidelines for type 1 diabetes
5. Table 3.5.5 General insulin dose reductions for endurance sports [5]
Chapter 4.2
1. Table 4.2.1 Type 2 diabetes. The symptoms and conditions that need preventing, addressing and, if necessary, treating
2. Table 4.2.2 Characteristics of insulin preparations to treat diabetes
Chapter 4.3
1. Table 4.3.1 Key recommendations for carbohydrate intake and glycaemic control in type 2 diabetes
Chapter 4.5
1. Table 4.5.1 Comparison of diet and behaviour interventions
Chapter 4.6
1. Table 4.6.1 Examples of aerobic and resistance training
2. Table 4.6.2 Levels of exercise recommended for weight loss and prevention of weight regain for adults [3]
Chapter 4.7
1. Table 4.7.1 Meta-analyses examining food intake relating to risk of Type 2 diabetes
2. Table 4.7.2 Selected screening and predictive tools for detecting undiagnosed type 2 diabetes
3. Table 4.7.3 Diabetes prevention studies with lifestyle change in diverse populations
Chapter 5.2
1. Table 5.2.1 Interventions to maintain glycaemia in type 1 diabetes, type 2 diabetes and gestational diabetes
2. Table 5.2.2 Target glucose concentrations during pregnancy
3. Table 5.2.3 Diagnosis of gestational diabetes
Chapter 6.1
1. Table 6.1.1 Aetiological classification of glycaemic disorders adapted from International Society for Pediatric and Adolescent Diabetes consensus guidelines 2009
Chapter 6.3
1. Table 6.3.1 Summary of strategies to support exercise management in children with type 1 diabetes
Chapter 7.2
1. Table 7.2.1 European Geriatrics Society and the International Diabetes Federation blood glucose, blood pressure and lipid targets for healthy and frail older people
2. Table 7.2.2 Overview of some of the factors that affect management decisions in older people with diabetes
Chapter 8.1
1. Table 8.1.1 Diabetes prevalence, by ethnicity, in the United States
Chapter 8.2
1. Table 8.2.1 Retrospective studies in atypical ketosis prone diabetes in different ethnic groups
Chapter 8.3
1. Table 8.3.1 Glycaemic index of South Asian foods
2. Table 8.3.2 Dietary modification of South Asian diet for diabetes
3. Table 8.3.3 Dietary modification of African-Caribbean diet for diabetes
Chapter 9.1
1. Table 9.1.1 Chronic kidney disease classification [3]
2. Table 9.1.2 Summary of the 2012 KDOQI Diabetes Guidelines
3. Table 9.1.3 Nutritional targets in CKD based upon NKF/KDOQI (2007), Renal Association Guideline (2011) [6], NICE Guidelines (2008) and British Dietetic Association Renal Nutrition Group (2011)
4. Table 9.1.4 The dietetic assessment of CKD stage 5 patients with or without diabetes
Chapter 9.2
1. Table 9.2.1 Current guidance on HbA1c targets and treatment interventions to achieve glucose control
2. Table 9.2.2 Current guidance blood pressure targets and treatment regimens
3. Table 9.2.3 Current guidance for lipid profile targets and treatment options
4. Table 9.2.4 Current guidance for antiplatelet therapy
5. Table 9.2.5 Current guidance for lifestyle interventions for patients at risk of diabetes
Chapter 9.3
1. Table 9.3.1 Foods permitted and not permitted on a gluten free diet
Chapter 9.5
1. Table 9.5.1 Characteristics of cystic fibrosis-related diabetes, type 1 and type 2 diabetes
2. Table 9.5.2 Classification of glucose tolerance abnormalities in cystic fibrosis
3. Table 9.5.3 Nutritional management of cystic fibrosis-related diabetes, type 1 and type 2 diabetes [34]
Chapter 9.6
1. Table 9.6.1 Grades of severity of gastroparesis

List of Illustrations

Chapter 2.3
1. Figure 2.3.1 Potential mechanism by which consumption of fructose affects lipid metabolism and insulin sensitivity: Unregulated fructose uptake by the liver, mediated primarily by phosphorylation via fructokinase (a), leads to increased DNL (b). DNL increases the intra-hepatic lipid supply directly, via synthesis of fatty acids (d), and indirectly, by inhibiting fatty acid oxidation (c)(e). Increased levels of intra-hepatic lipid content promote VLDL production and secretion (f), which leads to dyslipidemia (g) and increased CVD risk (h). Increased levels of hepatic lipids may also promote hepatic insulin resistance by increasing levels of DAG, which activates nPKC and leads to serine phosphorylation of the insulin receptor and IRS-1 and impaired insulin action (i). Increased exposure to circulating triglyceride may lead to the accumulation of intramyocellular lipid in skeletal muscle (j), impaired DAG-mediated insulin signalling, and whole body insulin resistance (k). This sequence of events is likely to be exacerbated by hepatic insulin resistance, uric acid production, and inflammatory factors. Due to selective insulin resistance, DNL is even more strongly activated in the insulin resistant liver DNL (l.), which has the potential to generate a vicious cycle (black arrows). This cycle would be expected to further exacerbate VLDL production and secretion by increasing the intra-hepatic lipid supply. Hepatic insulin resistance also exacerbates VLDL production/secretion by increasing apoB availability and MTP expression (m). The unregulated fructose uptake by the liver, mediated by fructokinase, also leads to increased production of uric acid via the purine degradation pathway (n). This pathway may indirectly contribute to the liver lipid supply by concurrently generating mitochondrial oxidants that up-regulate DNL (o). Uric acid may also promote fructose uptake into the liver by up-regulating expression of fructokinase (p) and may contribute to the accumulation of lipid in the liver by inhibiting AMP-activated kinase, an activator of fatty acid oxidation (q). Inflammatory responses to fructose may impair hepatic insulin signalling (r) or increase hepatic lipid levels (s). These may be mediated by fructose-induced increases of visceral adipose which increase MCP-1 and PAI-1 (t), or fructose exposure to intestine which increases translocation of bacterial endotoxin (u), or exposure to hepatocytes which increases JNK activation (v)
Chapter 3.1
1. Figure 3.1.1 Incidence rates of type 1 diabetes with onset in the age range 0–29 years in 1996–1997 for three European countries.
2. Figure 3.1.2 Top 10 countries incidence rate for type 1 diabetes in children (0–14 years). Only countries where studies have been carried out in that country are included.
3. Figure 3.1.3 Incidence of type 1 diabetes in children 0–14 years worldwide (cases per 100 000 population per year.
4. Figure 3.1.4 Immunological basis for type 1 diabetes.
Chapter 3.2
1. Figure 3.2.1 This cartoon illustrates the key components of an insulin pump device as would be worn by a patient. A reservoir pumps insulin through tubing into a subcutaneous catheter at a predetermined rate.
Chapter 3.5
1. Figure 3.5.1 The contribution of energy sources used depending on the duration of the activity
Chapter 4.1
1. Figure 4.1.1 Prevalence (%) of diabetes in adults (20–79 years), 2013.
2. Figure 4.1.2 Dynamic systems in the beta-cell. The boxed items are pathological mechanisms variously proposed to explain the beta-cell dysfunction
3. Figure 4.1.3 Community interventions can be cost saving. Labelling, advertising and prompts all help to reduce the risks of diabetes
Chapter 4.2
1. Figure 4.2.1 Glycaemic goals need to be personalised for each patient. A young, highly motivated patient with no comorbidity should have stringent goals. By contrast, an elderly patient with low life expectancy and poor health-care support may need less stringent control. The lines on each triangle show how each of these characteristics may have an influence on where the final target is set
2. Figure 4.2.2 Therapy of type 2 diabetes is based on a background of healthy eating, weight control and increased physical activity. Beyond this, metformin is usually the first line agent and two-drug combinations or three-drug combinations can be used. When β-cell failure becomes severe, insulin is the only option
Chapter 7.1
1. Figure 7.1.1 Pathogenesis of type 2 diabetes in older people
2. Figure 7.1.2 Main risk factors and prevention of type 2 diabetes in older people
Chapter 8.1
1. Figure 8.1.1 Prevalence of doctor-diagnosed diabetes, by sex, within minority ethnic groups aged 55 years and over
2. Figure 8.1.2 Prevalence of diabetes for ethnic groups of the US compared to their countries of origin.
3. Figure 8.1.3 Prevalence of diabetes in various US ethnic groups (Mokdad et al., 2000, 2001).

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Library of Congress Cataloging-in-Publication Data

Advanced nutrition and dietetics in diabetes / edited by Louise Goff & Pamela Dyson.
p. ; cm. – (Advanced nutrition and dietetics (BDA))
Includes bibliographical references and index.

ISBN 978-0-470-67092-7 (pbk.)
I. Goff, Louise, editor. II. Dyson, Pamela, editor. III. Series: Advanced nutrition and dietetics (BDA)
[DNLM: 1. Diabetes Mellitus–diet therapy. 2. Diabetic Diet. 3. Health Behavior. 4. Life Style. 5. Nutrition Therapy. WK 818]j
RC662
616.4′620654–dc23

2015022542

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Preface

Diabetes has been with us since ancient times, and the first mention of an illness that could be diabetes was recorded in an Egyptian papyrus of 1500 BC. A simplistic definition of diabetes is that of a disease typified by excessively high blood glucose concentrations, but this conceals the true nature of diabetes as a complex biochemical disorder affecting carbohydrate, fat and protein metabolism. Treatment of diabetes is multifactorial and aims to reduce both short- and long-term complications of the disease while maintaining quality of life. Diabetes belongs to the group of diseases that cannot be managed by medication alone, and lifestyle factors, including diet and physical activity, are fundamental to successful management. Dietary advice has been subject to various fashions over the years from low to high carbohydrate (and back) and each new approach has been greeted with almost equal amounts of enthusiasm and criticism. The fundamental question for all health professionals concerned with the management of diabetes is – what is the best diet for diabetes?

Evidence-based medicine (and lifestyle advice) is the cornerstone of successful management, and although there are numerous randomized controlled trials indicating the efficacy and safety of most medications used to treat diabetes, this is not always true of lifestyle interventions. Many studies designed to investigate the effects of lifestyle and dietary interventions are not well-designed and there are issues with small numbers of subjects, lack of comparison or control groups, study design and intervention, data quality, data reporting and target populations. It is impossible to conduct randomized, controlled trials in free-living populations over the periods of time required for unambiguous results, and in many cases short-term trials using surrogate end-points are the only evidence available. Despite this, many national and international diabetes associations now publish evidence-based guidelines and recommendations for the dietary management of diabetes, although most of these guidelines identify areas where there is little evidence and recommendations are made based on consensus opinion.

This book is designed to offer both evidence for and the practical aspects of the nutritional management of diabetes, and offers a global view of the lifestyle interventions for the prevention and management of diabetes, including management of complications and special groups. Recognized authorities from around the world have shared their expertise in areas such as the management of diabetes in older people, the glycaemic index, public health and prevention and formulating nutritional guidelines. The book is divided into nine different sections, each addressing a particular aspect of diabetes and each providing a critical review of key literature in the area with an emphasis on translating evidence into practice. The epidemiology, aetiology and clinical management of diabetes are addressed, with an emphasis on lifestyle management, and specifically diet and nutrition, in all areas of the treatment and prevention of diabetes.

This book is aimed at those who work at an advanced level in diabetes, including clinicians, researchers and educators, and is intended for the multi-disciplinary team, including specialist dietitians, diabetes specialist nurses, physicians and psychologists. It will also appeal to general dietitians who wish to learn more about diabetes, and to those undertaking Masters degrees in dietetics, nutrition, medicine or nursing with a specific diabetes component. It is a useful reference and resource for those teaching diabetes at any level.

Louise Goff PhD RD
Senior Lecturer in Nutritional Sciences
King's College London

Pamela Dyson PhD RD
Research Dietitian
University of Oxford
Editors
Advanced Nutrition and Dietetics in Diabetes

This book is the second title in a series commissioned as part of a major initiative between the British Dietetic Association and the publishers Wiley. Each book in the series provides a comprehensive and critical review of the key literature in a clinical area. Each book is edited by one or more experts who have themselves undertaken extensive research and published widely in the relevant topic area. Each book chapter is written by experts drawn from an international audience and from a variety of disciplines as required of the relevant chapter (e.g. dietetics, medicine, public health, basic sciences). Future titles in the series will cover areas including obesity and nutritional support.

The book editors and I are proud to present the second title in the series: Advanced Nutrition and Dietetics in Diabetes. We hope that it impacts on health professionals’ understanding and application of nutrition and dietetics in the prevention and management of diabetes and improves outcomes and reduces complications for such patients.

Kevin Whelan PhD RD
Professor of Dietetics
King’s College London
Series Editor
Advanced Nutrition and Dietetics Book Series

Contributors

Ahmed H Abdelhafiz MD FRCP
Consultant Physician, Honorary Senior Clinical Lecturer
Rotherham General Hospital
Rotherham, UK

Francesca Annan MSc RD
Paediatric Diabetes Dietitian
Alder Hey Children’s NHS Foundation Trust
Liverpool, UK

Suzanne Barr PhD RD
Research Dietitian
Imperial College London
London, UK

Pratik Choudhary MD MRCP
Consultant Diabetologist and Senior Lecturer
King’s College Hospital NHS Foundation Trust and King’s College London
London, UK

Thushara Dassanayake BSc RD
Specialist Renal Dietitian
Imperial College Healthcare NHS Foundation Trust
London, UK

Trudi Deakin PhD RD
Consultant Diabetes Dietitian
X-PERT Health Charity
Hebden Bridge, UK

Anne Dornhorst DM FRCP
Imperial College Healthcare NHS Foundation Trust
London, UK

Alastair Duncan MSc RD
Principal Dietitian
Guy’s and St Thomas’ NHS Foundation Trust
London, UK

Trisha Dunning AM
Professor of Nursing
Deakin University and Barwon Health
Victoria, Australia

Pamela Dyson PhD RD
Research Dietitian
University of Oxford, Oxford Centre for Diabetes Endocrinology and Metabolism, Churchill Hospital
Oxford, UK

Marion J. Franz MS RD
Nutrition Concepts by Franz, Inc.
Minneapolis, USA

Maeve Gacquin BSc MINDI
Senior Dietitian
Galway Clinic
Doughiska, Ireland

Louise Goff PhD RD
Senior Lecturer in Nutritional Sciences
King’s College London
London, UK

Simon Heller DM FRCP
Professor of Clinical Diabetes
University of Sheffield
Sheffield, UK

C. Jeya Henry PhD
Professor and Director of Clinical Nutritional Sciences
National University of Singapore
Singapore

Elaine Hibbert-Jones BSc RD
Chief Diabetes Dietitian
Royal Gwent Hospital
Newport, UK

Alyson Hill PhD RD
Lecturer in Dietetics
University of Ulster
Londonderry, UK

Mohammed S. B. Huda PhD MRCP
Consultant in Diabetes and Endocrinology Barts Health NHS Trust London, UK

Ahmed Iqbal MBBS MRCP
MRC Fellow in Diabetes and Endocrinology
University of Sheffield
Sheffield, UK

David R. Matthews DPhil FRCP
Professor in Diabetic Medicine and Emeritus Founding Chairman of OCDEM
University of Oxford, Oxford Centre for Diabetes Endocrinology and Metabolism
Oxford, UK

Hilary McCoubrey BSc RD
Paediatric Diabetes Dietitian
Birmingham Children’s Hospital
Birmingham, UK

Shivani Misra MSc MRCP
Specialist Registrar in Diabetes and Endocrinology
Imperial College Healthcare NHS Foundation Trust
London, UK

Lindsay Oliver BSc RD
Consultant Dietitian in Diabetes
North Tyneside General Hospital
North Shields, UK

Sathish Parthasarathy MBBS MRCP
Specialist Registrar in Diabetes and Endocrinology
King’s College Hospital NHS Foundation Trust
London, UK

Princy Paul
Consultant Pediatrician and Lead for Diabetes
Alder Hey Children’s NHS Foundation Trust
Liverpool, UK

Baldeesh Rai BSc RD
Specialist Cardiac Dietitian
London North West Healthcare NHS Trust
London, UK

Alan J. Sinclair MD FRCP
Dean and Professor of Medicine
Bedfordshire & Hertfordshire PG Medical School
Luton, UK

Kimber L. Stanhope PhD RD
Associate Research Nutritional Biologist
University of California
Davis, USA

P. Sangeetha Thondre PhD
Post-Doctoral Research Fellow
Oxford Brookes University
Oxford, UK

Nicola Tufton MRCP
Specialist Registrar in Diabetes and Endocrinology
Barts Health NHS Trust London, UK

Karen Walker PhD
Associate Professor of Nutrition
Monash University
Melbourne, Australia

Kerry-Lee Watson BSc RD
Specialist Cystic Fibrosis Dietitian
King’s College Hospital NHS Foundation Trust
London, UK

Catherine Whitmore RN
Research Nurse in Diabetes and Endocrinology
University of Liverpool
Liverpool, UK

John Wilding DM FRCP
Professor of Medicine, Head of the Department of Obesity and Endocrinology
University of Liverpool
Liverpool, UK

Katie Wynne PhD MRCP
Hunter New England Health and University of Newcastle
Newcastle, Australia

Abbreviations

AACE	American Association of Clinical Endocrinologists
ABCD	Association of British Clinical Diabetologists
ACCORD	Action to Control Cardiovascular Risk in Diabetes
ACE	Angiotensin converting enzyme inhibitor
ACSM	American College of Sports Medicine
ADA	American Diabetes Association
ADS	Australian Diabetes Society
ADP	Adenosine diphosphate
ADVANCE	Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation
AGS	American Geriatrics Society
AKPD	Atypical ketosis prone diabetes
AMP	Adenosine monophosphate
AMPK	AMP-activated kinase
apoB	Apolipoprotein B100
ARB	Angiotensin receptor blockade
ASDIAB	Asian Young Diabetes Research Study
ATP	Adenosine triphosphate
AUC	Area under the curve
BG	Blood glucose
BMI	Body mass index
BP	Blood pressure
CAPD	Continuous ambulatory peritoneal dialysis
CARE	Cholesterol and Recurrent Events study
CD	Coeliac disease
CEMACH	Confidential enquiry into maternal and child health
CF	Cystic fibrosis
CFRD	Cystic fibrosis-related diabetes
CHD	Coronary heart disease
CI	Confidence interval
CKD	Chronic kidney disease
CMV	Cytomagelavirus
CSII	Continuous subcutaneous infusion of insulin
CVD	Cardiovascular disease
DAFNE	Dose adjusted for normal eating
DAG	Diacylglycerol
DASH	Dietary approaches to stop hypertension
DCCT	Diabetes Control and Complications Trial
DE-PLAN	Prevention using lifestyle, physical activity and nutrition intervention
DGP	Diabetic gastroparesis
DiaMond	Diabetes mondiale project group
DKA	Diabetic ketoacidosis
DMEG	Diabetes Management and Education Group
DNA	Deoxyribonucleic acid
DNL	De novo lipogenesis
DPP-4	Dipeptidyl peptidase 4
DPP	Diabetes prevention programme
DPS	Diabetes prevention study
DR	Diabetic retinopathy
DSME	Diabetes self-management education
Early ACTID	Activity early in diabetes
EASD	European Association for the Study of Diabetes
EDIC	Epidemiology of Diabetes Interventions and Complications trial
EPBP	European Best Practice (Guidelines)
ESPEN	European Society for Clinical Nutrition and Metabolism
EURODIAB	European type 1 diabetes study
FAI	Free androgen index
FAO	Food and Agriculture Organisation
FEV1	Forced expiratory volume in 1 second
FIN-D2	Finland type 2 diabetes prevention programme
FPG	Fasting plasma glucose
FSA	Food Standards Agency
FSH	Follicle stimulating hormone
FTO	Fat mass and obesity-associated protein
GAD	Glutamic acid decarboxylase
GDA	Guideline daily amount
GDM	Gestational diabetes mellitus
GORD	Gastro-oesophageal reflux
GES	Gastric emptying scintigraphy
GF	Gluten-free
GFD	Gluten-free diet
GFR	Glomerular filtration rate
GI	Glycaemic index
GIP	Gastric Inhibitory polypeptide
GL	Glycaemic load
GLP-1	Glucagon-like peptide-1
GPEDM	Global Partnership for Effective Diabetes Management
GWAS	Genome-wide association studies
HAART	Highly active antiretroviral therapy
HbA1c	Glycated haemoglobin (haemoglobin A1c)
HD	Haemodialysis
HDL	High density lipoprotein
HFCS	High fructose corn syrup
HHS	Hyperosmotic hyperglycaemic state
HIV	Human immunodeficiency virus
HLA	Human leucocyte antigen
HOPE	Heart Outcomes Prevention Evaluation
HOT	Hypertension optimal treatment
IBW	Ideal body weight
IDF	International Diabetes Federation
IFCC	International Federation of Clinical Chemistry
IFG	Impaired fasting glycaemia
IGT	Impaired glucose tolerance
ILI	Intensive lifestyle interventions
IOM	Institute of Medicine
IR	Insulin resistance
IRS-1	Insulin receptor substrate-1
ISPAD	International Society for Paediatric and Adolescent Diabetes
IV	Intravenous
JBDS	Joint British Diabetes Society
JNK	c-jun NH₂-terminal kinase
LADA	Latent autoimmune diabetes in adults
LDL	Low density lipoprotein
LH	Lutenising hormone
LMIC	Low and middle-income countries
LPL	Lipoprotein lipase
Look AHEAD	Action for health in diabetes
MCP-1	Monocyte chemoattractant protein-1
MDI	Multiple daily injections
MDT	Multidisciplinary team
MICS	Malnutrition-inflammation complex syndrome
MODY	Maturity onset diabetes of the young
MRFIT	Multiple Risk Factor Intervention Trial
MTP	Microsomal triglyceride-transfer protein
MUFA	Monounsaturated fat
NaDIA	National diabetes inpatient audit
NAFLD	Non-alcoholic fatty liver disease
NASH	Non-alcoholic steatohepatitis
NCD	Non-communicable disease
NGT	Normal glucose tolerance
NHS	National Health Service
NICE	National Institute of Health and Clinical Excellence
NODAT	New-onset diabetes after organ transplantation
NPH	Neutral protamine Hagedorn
nPKC	Novel-protein kinase C
OGTT	Oral glucose tolerance test
ONS	Oral nutritional supplements
PAD	Peripheral arterial disease
PAI-1	Plasminogen activator inhibitor-1
PCOS	Polycystic ovary syndrome
PD	Peritoneal dialysis
PEM	Protein energy malnutrition
PNDM	Permanent neonatal diabetes
PPARγ	Peroxisome proliferator-activated receptor gamma
PUFA	Polyunsaturated fat
PVD	Peripheral vascular disease
QUM	Quality use of medicines
RACF	Residential aged care facility
RACGP	Royal Australian College of General Practitioners
RAS	Renin-angiotensin-aldosterone system
RCPCH	Royal College of Paediatrics and Child Health
RCT	Randomised controlled trial
RD	Registered dietitian
RDA	Recommended daily allowance
RNI	Reference nutrient intake
RR	Relative risk
RT-CGM	Real-time continuous glucose monitoring
SABRE	Southall and Brent Revisited Study
SFA	Saturated fatty acid
SGLT-2	Sodium glucose transporter 2
SHBG	Sex hormone binding globulin
4S	Scandinavian Simvastin Survival Study
4-T	Treating to Target in Type 2 diabetes Trial
TC	Total cholesterol
TDD	Total daily dose
TNDM	Transient neonatal diabetes
TODAY	Treatment options for type 2 diabetes in adolescents and youth
TPN	Total parenteral nutrition
TZD	Thiazolidinedione
UKPDS	UK Prospective Diabetes Study
VACSDM	Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus
VADT	Veteran Affairs Diabetes Trial
VA-HIT	Veterans Affairs High Density Lipoprotein Cholesterol Intervention Trial
VLDL	Very low density lipoprotein
VO₂max	Maximum capacity of an individual’s body to transport and use oxygen
VRIII	Variable rate intravenous insulin infusion
WC	Waist circumference
WHO	World Health Organisation

Advanced Nutrition and Dietetics in Diabetes

ADVANCED NUTRITION AND DIETETICS BOOK SERIES

Preface

Foreword

Editor biographies

Contributors

Abbreviations

SECTION 1
Background