THE BEST MANAGEMENT DIET IN CLINICAL TREATMENT FOR DM PATIENT Budiyanti Wiboworini*

Glycemic control is fundamental to the management of diabetes. Medical nutrition therapy (MNT) is an important way to maintained glycemic control. Individuals who have prediabetes or diabetes should receive individualized medical nutrition therapy (MNT) as needed to achieve treatment goals. MNT can be used as prevention or part of treatment in diabetes. As prevention, weight loss is recommended for all overweight or obese individuals at risk for diabetes. Its suggested to reach ideal body weight. Many researches showed that in overweight and obese individuals, modest weight loss has been shown to reduce insulin resistance. Many types of diet can be used. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Individuals at high risk for type 2 diabetes should be encouraged to achieve dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intakes). Monitoring carbohydrate is a key strategy for achieving glycemic control. The best mix of carbohydrate, protein, and fat should be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. Saturated fat intake should be below 7% of total calories. Intake of trans fat should be minimized. Individualized meal planning should cover recommended dietary allowance (RDA) for all micronutrients. For diabetic person, MNT is recommended as first step in glycemic control. Diabetic person still can eat family meals, but they should concern about the portion, type of foods and timing for eating. For person with diabetes, the use of the glycemic index and glycemic load give additional benefit for glycemic control rather than total carbohydrate is considered alone. Although low-fat diets have traditionally been promoted for weight loss, several randomized controlled trials found that subjects on low-carbohydrate diets (<130 g/day of carbohydrate) lost more weight at 6 months than subjects on low-fat diets. In longer time (1 year), the difference was not significant. A recent meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets However, its not recommended to achieve carbohydrate less than 130 g/day. Macronutrient composition must be arranged individually, depend on patient condition. The metabolic status of the patient, lipid profile, renal function, food preferences and allergies are factors affected nutrient needs. Total caloric intake must be appropriate for weight management goal. Like in normal diet, the proportion of carbohydrate should
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meet 45-65% total energy intake. Individuals with diabetes have to limit saturated fatty acids, trans fatty acids, and cholesterol intake in order to reduce risk for CVD. Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. Total fat not more than 30% total energy intake and protein 10-20% unless nephropathy. Avoid high-protein weight-loss diets and micronutrient supplementation except for specific deficiencies. All nutrition needs distributed throughout the day: 20% for breakfast; 30% lunch; 25% dinner and 2-3 portions of snacks (10-15%). Specific nutritional interventions are needed for individuals with diabetes who are experiencing microvascular complications, cardiovascular disease, hypertension, hypoglycemia, and acute illness. References: American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care 34 (Suppl 1), January 2011 Haimoto H, Sasakabe T, Umegaki H, Wakai K. 2009. Acute Metabolic Responses to a High-carbohydrate Meal in Outpatients with Type 2 Diabetes Treated with a Lowcarbohydrate Diet: A Crossover Meal Tolerance Study. Nutr Metab. 6:52 Newman L. 2012. Excess Calories, Not Proportion of Dietary Protein, Key in Causing Obesity. Medscape Medical News. PERKENI. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2011. Perkumpulan Endokrinologi Indonesia.

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