Abstract
Type 2 diabetes mellitus has a high prevalence worldwide, with a rapidly increasing incidence even in youth. Nutrition, dietary macronutrient composition, and in particular dietary carbohydrates play a major role in the development of type 2 diabetes. The aim of this narrative review is to discuss the current evidence on the role of dietary carbohydrates in the prevention and management of type 2 diabetes. The digestibility or availability of carbohydrates and their glycemic index (and glycemic load) markedly influence the glycemic response. High consumption of dietary fiber is beneficial for management of type 2 diabetes, whereas high consumption of both glycemic starch and sugars may have a harmful effect on glucose metabolism, thereby increasing the risk of developing type 2 diabetes in the presence of genetic predisposition or making its glycemic control more difficult to achieve in people with established T2D. Therefore, the same dietary macronutrient may have harmful or beneficial effects on type 2 diabetes mainly depending on the subtypes consumed. Some other factors are involved in glucose metabolism, such as meal composition, gut microbiota and genetics. For this reason, the glycemic response after carbohydrate consumption is not easy to predict in the single individual. Nutrition suggested to subjects with known type 2 diabetes should be always person-centered, considering the individual features of each subject.
Highlights
Diabetes affects approximately 463 million people worldwide, and up to nearly 95%have type 2 diabetes mellitus (T2D) [1,2]
Several factors may be involved in the anticipation of T2D onset, the dramatic increase in childhood and adolescent obesity worldwide plays a key role in this process [5]
The main aim of this narrative review is to briefly discuss the current knowledge about the role of dietary carbohydrate intake in T2D prevention and treatment, underlining how diet may be modulated to reduce risk of incident T2D and ameliorate the management of the disease. References for this narrative Review were identified through searches of PubMed, Medline and Cochrane Library databases with the following search terms: “type 2 diabetes and nutrition”, “type 2 diabetes and carbohydrates”, “type 2 diabetes in adolescents”, “type 2 diabetes in young people”, “type 2 diabetes and gut microbiota”, “type 2 diabetes and genetics”, and “low-calorie sweeteners and glucose metabolism” from the inception date to 20 September 2021
Summary
Diabetes affects approximately 463 million people worldwide, and up to nearly 95%. have type 2 diabetes mellitus (T2D) [1,2]. Several factors may be involved in the anticipation of T2D onset, the dramatic increase in childhood and adolescent obesity worldwide plays a key role in this process [5]. Chronic energy intake (beyond required levels) can promote fat mass increase and body composition changes, with negative implications on glucose metabolism, i.e., glucose oxidation and storage, insulin sensitivity, and insulin secretion [10]. The strong association between dietary carbohydrates and glycemic control demonstrated in individuals with T2D further emphasizes the need to identify for each subject the total amount of carbohydrate intake, as well as the best carbohydrate composition of his/her diet, taking into account the protein, fat, and fiber contents of the diet. The main aim of this narrative review is to briefly discuss the current knowledge about the role of dietary carbohydrate intake in T2D prevention and treatment, underlining how diet may be modulated to reduce risk of incident T2D and ameliorate the management of the disease
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