SINGAPORE - Eating right is essential to preventing and treating diabetes. Many diabetics need to lose weight but it is not as simple as eating fewer calories.
They also need to have the right nutrients and in the correct quantities, said DrJeffrey Mechanick, a clinical professor at the division of endocrinology, diabetes and bone disease at the Mount Sinai School of Medicine in New York City in the United States.
The right nutrients include essential vitamins and minerals within a restricted calorie count.
This is where meal replacements can help, said Dr Mechanick, who was in town recently to talk to doctors about medical nutrition therapy and a new tool to calculate nutritional needs for patients with diabetes and pre-diabetes.
Medical nutrition therapy involves dietary counselling and a recommended diet plan.
Pre-diabetes is when glucose levels are higher than normal but not high enough to be diagnosed as diabetes.
A reading between 7.8 and 11millimoles per litre for the blood sugar levels taken after two hours in an oral glucose tolerance test indicates a pre-diabetic state.
Some recent and ongoing studies have shown that diet counselling to manage diabetes by a registered dietitian or nutrition professional and taking meal replacements have helped diabetics lose weight and keep it off for a longer period, while ensuring they have all the nutrients they need, Dr Mechanick said.
Meal replacement, in particular, also helps manage blood sugar levels in people with diabetes because it contains slow-releasing carbohydrates, he added.
Meal replacements can comprise drinks, powder mixes and nutrition bars. Patients do well with meal replacements as they are spared the task of looking for appropriate food, especially when they are busy at work.
A meta-analysis of 23 clinical studies on more than 800 patients who consumed diabetes-specific meal replacements found that patients experienced significantly lower blood sugar spikes after meals, DrMechanick said.
This was the case with both long- and short-term use of the replacements. Dr Mechanick said another ongoing study, the Look Ahead study, of 5,145 overweight and obese men and women with type 2 diabetes found that those who had weekly educational sessions about managing their disease and meal replacements lost an average of 4.7 per cent of their initial weight after four years.
In contrast, patients who had no more than three educational sessions in the four years and no meal replacement lost an average of 1.1 per cent. The study was initiated by the National Institutes of Health in the US and partly funded by meal replacement maker Abbott.
Diabetes is a growing problem here. As many as one in three Singaporeans will develop this metabolic disease by the time they are 69.
In 2010, 11.3 per cent of people aged 18 to 69 were living with diabetes, up from 8.2 per cent in 2004. People with this condition have high blood sugar, either because their bodies do not produce enough insulin, or because their cells do not respond to the insulin that is produced to break food down into energy.
Dr Stanley Liew, a consultant endocrinologist at Raffles Hospital, said most patients being monitored by doctors receive diet advice.
Dr Peter Eng, a consultant endocrinologist at Mount Elizabeth Medical Centre, said all patients with pre-diabetes or diabetes should receive dietary counselling and advice on exercise, which are the cornerstones in the management of diabetes.
Though there are no studies which show that nutrition therapy directly increases the lifespan of diabetics, better blood sugar control lowers the risk of long-term heart complications, which is the leading cause of death in patients with diabetes.
While it is not necessary for patients to take meal replacements to achieve weight loss, some patients may take meal replacements because they are more convenient, Dr Eng said. “The meal replacement can give them what they need, in the correct amounts, especially when they are in a rush,” he said.
Medical nutrition therapy, which need not include meal replacements, can help a small number of patients lose enough weight to stop them from being diabetic, he added.
People deemed to be pre-diabetic could reduce their risk of developing diabetes if they lose excess weight.
New nutrition tool
Dr Mechanick said that although medical nutrition therapy is not a new concept, there needs to be more effort made to educate doctors about the role it can play in the treatment of diabetes.
Studies such as Look Ahead have demonstrated that nutrition, including the use of meal replacements, can be an important part of treatment.
To help doctors do so, a group of doctors and nutrition experts in the US that Dr Mechanick is a part of has come up with a new diabetes nutrition tool.
It is a decision tree that doctors can use to manage each patient’s nutritional needs based on factors such as his race, weight, body mass index, waist circumference and/or waist-hip ratio. It also accommodates differences in genetics, lifestyles and food preferences.
“We are working with Singapore endocrinologists to customise the tool for Singapore,” Dr Mechanick said.
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