[Role of diet in the treatment of diabetes]

Although diet has always been recognized as the cornerstone in the management of diabetes, dietary recommendations are evolving continuously. There is now some consensus that the goals of medical nutrition therapy should be to attain and/or maintain a reasonable body weight, to ensure the best possible glycemic control and to reduce cardiovascular risk factors but the means to achieve these goals are still under discussion. Apart from caloric restriction which is, without any doubt, highly efficient but hardly applied in obese diabetic patients, the clinical benefits of the traditional measures to alleviate postprandial hyperglycemia (increasing meal frequency, consumption of carbohydrates with a low glycemic index and/or rich in fibers) are not unanimously acknowledged. The hotly debated issue regarding the ideal proportions of carbohydrates and fat advisable for diabetic individuals has lapsed progressively into disuse, all the arguments having run out. At the present time, there remain many unanswered important questions related to nutrition and diabetes because of the lack of long-term randomized studies evaluating the impact of a diet modification on morbidity and mortality. Considering the difficulties of changing our usual feeding patterns on a long term basis, these uncertainties will not readily be solved.