The Harry Keen Rank Nutrition Lecture 2022. Nutritional guidelines for diabetes management: Where do they come from...

Nutritional guidelines for diabetes are designed to support those living with diabetes in achieving optimal glycaemic control, reducing the risk of cardiovascular disease and maintaining quality of life. Historically, guidelines reflected current opinion and clinical practice and only relatively recently have evidence-based recommendations been published. Current nutritional guidelines for type 1 and type 2 diabetes are based on high-quality evidence including data from randomised controlled trials and prospective cohort studies and are graded by the strength of evidence. There is no evidence to support one specific dietary strategy for people with diabetes, and this is particularly true for weight reduction in those with type 2 diabetes living with overweight or obesity, where the evidence suggests that different strategies are equally successful. As a result, the emphasis of modern guidelines is on individualised, person-centred approaches. Some barriers to successful implementation include lack of dietary education and knowledge in health professionals supporting people with diabetes, and a so-called obesogenic environment that impedes dietary change. Initiatives such as education and training programmes for health professionals, and population-based interventions that promote both structural and policy change are recommended to enable those with diabetes to support dietary change and improve health.