Individuals who manifest types 1 and 2 diabetes mellitus (DM), gestational diabetes or condition of hyperglycemia can benefit from the use of ONT, providing better quality of life and reduction of complications proceeding from blood glucose changes (1).
The American Diabetic Association (ADA) instructs on the early diagnosis of diabetes. Once this disorder is detected, the DM patient should maintain blood glucose control by preventing microvascular complications, such as diabetic nephropathy, diabetic retinopathy, diabetic foot, among others (2,3,4).
For monitoring of blood glucose levels there are some tools that can be used, such as self-monitoring of blood glucose through the capillary blood glucose test, which shows the blood glucose level at the exact time of testing. Glycated hemoglobin test (A1C) can also be used; a laboratory testing that reveals the average blood glucose levels in the last 2 to 4 months, which reveals whether diabetes control was well executed or not (5).
According to the ADA, the A1C should remain below 7% as goal for good blood glucose control. See table below (3).
Source: ADA, 2015
Experimental and observational studies of better consistency indicate with Evidence Grade A that:
• blood glucose changes can be considered an independent risk factor for diabetes complications (4,6);
• reduction of A1C levels (values below 7%) shows that it reduces microvascular and neuropathic complications, and consequently, macrovascular complications of diabetes, particularly type 1 diabetes (3,4).
Thus, diet is essential for success in the treatment of diabetic patients, because prolonged hyperglycemia promotes the development of extensive and irreversible damage in the eyes, kidneys, nerves, large and small vessels and also in blood clotting (3,6,7).
ADA data show that about 14% of pregnant women develop diabetes and 7% manifest complications proceeding from the blood sugar change. All women with gestational diabetes have been receiving nutritional guidance and a balanced diet in nutrients so as not to change the blood glucose level (2).
It can be said that: about 30% of patients admitted in intensive care units (ICU) are diabetic with cardiovascular disease; approximately 40% of diabetic patients develop diabetic nephropathy, the leading cause of dialysis; and around 40% of diabetic patients develop diabetic retinopathy, the leading cause of blindness. In addition to these complications, diabetes increases 100 times the chance of amputation of some limb. What is ideal is to maintain blood glucose homeostasis without abrupt changes, thus preventing microvascular complications (4,8).
Specific formulations for diabetic patients are characterized by increase of lipid content (> 40% of total energy intake) and reduction of carbohydrate content. Of these total lipids, 20% or more are monounsaturated fatty acids (MUFA). Thus, specific formulations allow better short and long term blood glucose control, with reduction of postprandial blood glucose in comparison with standard formulations for type 1 and 2 DM patients (7).