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© 2004 by the American Diabetes Association, Inc.
Reviews/Commentaries/ADA Statements |
Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes
A statement by the American Diabetes Association
1 Department of Family Practice, University of Vermont, Burlington, Vermont
2 American Diabetes Association, Alexandria, Virginia
3 Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, Sydney, Australia
4 Nutrition Concepts by Franz, Minneapolis, Minnesota
5 Division of Endocrinology, Diabetes and Nutrition, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
6 Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
7 St. Mark’s Diabetes Center, Salt Lake City, Utah
8 Diabetes Care and Communications, Lexington, Kentucky
Address correspondence to Nathaniel G. Clark, MD, MS, RD, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: nclark@diabetes.org
| The first 300 words of the full text of this article appear below. |
Diabetes has long been viewed as a disorder of carbohydrate metabolism due to its hallmark feature of hyperglycemia. Indeed, hyperglycemia is the cause of the acute symptoms associated with diabetes such as polydypsia, polyuria, and polyphagia (1). The long-term complications (retinopathy, nephropathy, and neuropathy) associated with diabetes are also believed to result from chronically elevated blood glucose levels (2–6). In addition, hyperglycemia may contribute to the development of macrovascular disease, which is associated with the development of coronary artery disease, the leading cause of death in individuals with diabetes (7–9). Thus, a primary goal in the management of diabetes is the regulation of blood glucose to achieve near-normal blood glucose.
What determines the postprandial blood glucose response?
Blood glucose concentration following a meal is determined by the rate of appearance of glucose into the blood stream (absorption) and its clearance/disappearance from the circulation (10). The rate of disappearance of glucose is largely influenced by insulin secretion and its action on target tissues (11).
The component of the diet that has the greatest influence on blood glucose is carbohydrate. Other macronutrients in the diet, i.e., fat and protein, can influence the postprandial blood glucose level, however. For example, dietary fat slows glucose absorption, delaying the peak glycemic response to the ingestion of a food that contains glucose (12–14). In addition, although glucose is the primary stimulus for insulin release, protein/amino acids augment insulin release when ingested with carbohydrate, thereby increasing the clearance of glucose from the blood (15–17).
Both the quantity and the type or source of carbohydrate found in foods influence postprandial glucose level (18,19). Although most experts agree that the total carbohydrate intake from a meal or snack is a
What is the glycemic index?
What is glycemic load?
If carbohydrates increase blood glucose, why not restrict total carbohydrate intake in individuals with diabetes?
What determines the glycemic effect of a carbohydrate-containing food?
Which has a greater influence on blood glucose, the type of carbohydrate or the total amount of carbohydrate?
What are some of the issues regarding the glycemic index?
What studies have examined the effectiveness of the glycemic index on overall blood glucose control?
What studies have examined the utility of the glycemic load?
Does a diet with a high glycemic index or load lead to diabetes?
Summary
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Diabetes Care 2006 29: S75-S77.
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