14 November marks World Diabetes Day, established by the United Nations. Between 1980 and 2017, the estimated number of people worldwide affected by the disease has almost quadrupled to 425 million adults.
Diabetes is diagnosed using several criteria:
Plasma glucose levels ≥ 200 mg/dL at any time of the day, regardless of food intake.
Basal blood glucose ≥ 126 mg/dL after an 8-hour fast.
Blood glucose at 2 hours after an oral intake of 75 g of glucose ≥ 200 mg/dL.
Glycosylated haemoglobin > 6.5% according to the National Glycohaemoglobin Standardisation Programme method.
There are mainly three types of diabetes:
- Type 1 diabetes, caused by insufficient insulin production to convert glucose from food into energy at the cellular level. This form of diabetes is hereditary in origin.
- Type 2 diabetes, caused by a progressive decrease in insulin production, insulin resistance and/or metabolic disturbances. It is not inherited and is usually associated with excess weight and accumulation of body fat in metabolically unhealthy individuals.
- Gestational diabetes mellitus, commonly diagnosed during the second or third trimester of pregnancy.
Insulin, a crucial hormone, facilitates the entry of glucose into cells for energy and regulates its concentration in the blood. Insulin resistance causes a rise in blood sugar by preventing the hormone from doing its job.
According to studies by the World Health Organisation (WHO) for the Prevention and Control of Non-Communicable Diseases (NCDs), diet, harmful alcohol consumption and lack of physical activity are risk factors for developing these diseases.
Lifestyle changes, such as adjusting diet, eliminating alcohol consumption and increasing physical activity, are key to addressing type 2 diabetes. SMART (Specific, Measurable, Achievable, Realistic, Time-bound, Achievable) goals are recommended in interventions aimed at these individuals.
In dietary interventions, goals such as controlling blood glucose and cardiovascular risk factors are pursued. Energy restriction, individualised counselling and food substitution have been shown to be effective therapies. There is no single ideal ratio of carbohydrate, protein and fat intake, although the Mediterranean diet appears to have positive effects on long-term glycaemic control.
The recommended diet includes foods such as whole grains, vegetables, fruits, legumes, low-fat dairy, lean meats, nuts and oilseeds, tailored to the patient’s health and preferences.
For overweight and obese patients, protein intake should be adjusted according to their specific situation. The dietary recommendations of the Spanish Agency for Food Safety and Nutrition (AESAN) do not support alcohol consumption, although some European and Spanish guidelines suggest integrating low-alcoholic beverages into the Mediterranean diet.
Before exercise, specific precautions should be taken for people with diabetes, such as performing stress tests, maintaining adequate hydration and having fast-acting carbohydrate sources available to treat hypoglycaemia.
The American College of Sports Medicine (ACSM) recommends four types of exercise for patients with type 2 diabetes, although only aerobic and strength exercise can control blood glucose.
In conclusion, diabetes is a prevalent and non-communicable disease, so it is crucial to seek guidance from nutrition and sports professionals to follow appropriate recommendations. Those with this condition should be aware of the importance of exercising safely.
Nutritional and exercise recommendations for people with type 2 diabetes. Specialisation Group on Nutrition and Dietetics for Physical Activity and Sport, Spanish Academy of Nutrition and Dietetics.