Rationale for changes in the dietary management of diabetes. Fat, carbohydrate, and fiber

Roughly three-quarters of Americans with diabetes die from atherosclerosis. Although the pathogenesis of cardiovascular disease in diabetes is not completely understood, diabetes is frequently associated with hyperlipidemia, often considered a major determinant of atherosclerosis, and with hyperglycemia, which may function as an independent risk factor. The new higher carbohydrate diets for management of diabetes facilitate reduction in the proportion of fat kilocalories. When total kilocalories are controlled, improvement in glucose tolerance also occurs in individuals with diabetes who have available endogenous or exogenous insulin. It has recently been demonstrated in subjects with diabetes that a mixture of carbohydrate and fiber and a high, rather than low, level of carbohydrate facilitate glycemic control. Inclusion of fiber-rich foods in meal plans for patients with diabetes augments established modes of therapy, which focus on weight control for Type II diabetes while synchronizing food intake and insulin for Type I diabetes.