The literature on nutrition as it r

The literature on nutrition as it relates to diabetes management is vast. We undertook the specific topic of the role of macronutrients, eating patterns, and individual foods in response to continued controversy over independent contributions of specific foods and macronutrients, independent of weight loss, in the management of diabetes. The position of the American Diabetes Association (ADA) on MNT is that each person with diabetes should receive an individualized eating plan (4). ADA has received numerous criticisms because it does not recommend one specific mix of macronutrients for everyone with diabetes. The previous literature review conducted by ADA in 2001 supported the idea that there was not one ideal macronutrient distribution for all people with diabetes. This review focuses on literature that has been published since that 2001 date (5). This systematic review will be one source of information considered when updating the current ADA Nutrition Position Statement (4). Other systematic reviews and key research studies that may not be included in this review will also be considered.
When attempting to tease out the role of macronutrients from other dietary and lifestyle factors, two critical components of MNT - energy balance and a healthful eating pattern - are not addressed. While both are critical components in the management of diabetes as well as the secondary prevention of complications and promotion of health, these topics are beyond the scope of this particular review. The following questions are addressed in this review:
1 . What aspects of macronutrient quantity and quality impact glycémie control and cardiovascular disease (CVD) risk in people with diabetes?
2. How do macronutrients combine in whole foods and eating patterns to affect health in people with diabetes?
3. Is there an optimal macronutrient ratio for glycémie management and CVD risk reduction in people with diabetes?
4. What findings and needs should direct future research?
Systematic review procedure- A search of the PubMed database was conducted using the search terms "diabetes" and one of a number of words (low-fat diet, low-carbohydrate diet, Mediterranean diet, Mediterranean eating pattern, vegetarian, vegan, glycémie index (GI), dietary carbohydrates, dietary protein, total fat, dietary fat, saturated fat, omega-3 fatty acid, dietary fiber, meats, legumes, nuts, fruit, vegetables, whole grains, milk) to identify articles published between January 2001 and October 2010. Certain terms relevant to nutrition therapy in the management of diabetes were not included in the search terms. These terms include trans fatty acids, monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), sucrose, and sugars. The literature search was limited to articles published in English, and multiple publications from the same study were limited to the primary study results article.