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Analysis Science and Politics of Nutrition

Dietary and nutritional approaches for prevention and management of type 2 diabetes

BMJ 2018; 361 doi: (Published 13 June 2018) Cite this as: BMJ 2018;361:k2234

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  1. Nita G Forouhi, professor1,
  2. Anoop Misra, professor2,
  3. Viswanathan Mohan, professor3,
  4. Roy Taylor, professor4,
  5. William Yancy, director5 6 7
  1. 1MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, and National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
  3. 3Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
  4. 4Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
  5. 5Duke University Diet and Fitness Center, Durham, North Carolina, USA
  6. 6Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  7. 7Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, North Carolina, USA
  1. Correspondence to: N G Forouhi nita.forouhi{at}

Common ground on dietary approaches for the prevention, management, and potential remission of type 2 diabetes can be found, argue Nita G Forouhi and colleagues

Dietary factors are of paramount importance in the management and prevention of type 2 diabetes. Despite progress in formulating evidence based dietary guidance, controversy and confusion remain. In this article, we examine the evidence for areas of consensus as well as ongoing uncertainty or controversy about dietary guidelines for type 2 diabetes. What is the best dietary approach? Is it possible to achieve remission of type 2 diabetes with lifestyle behaviour changes or is it inevitably a condition causing progressive health decline? We also examine the influence of nutrition transition and population specific factors in the global context and discuss future directions for effective dietary and nutritional approaches to manage type 2 diabetes and their implementation.

Why dietary management matters but is difficult to implement

Diabetes is one of the biggest global public health problems: the prevalence is estimated to increase from 425 million people in 2017 to 629 million by 2045, with linked health, social, and economic costs.1 Urgent solutions for slowing, or even reversing, this trend are needed, especially from investment in modifiable factors including diet, physical activity, and weight. Diet is a leading contributor to morbidity and mortality worldwide according to the Global Burden of Disease Study carried out in 188 countries.2 The importance of nutrition in the management and prevention of type 2 diabetes through its effect on weight and metabolic control is clear. However, nutrition is also one of the most controversial and difficult aspects of the management of type 2 diabetes.

The idea of being on a “diet” for a chronic lifelong condition like diabetes is enough to put many people off as knowing what to eat and maintaining an optimal eating pattern are challenging. Medical …

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