Dietary Management of Type 2 Diabetes Resource Pack - Thames Valley Dietitian Forum September 2019
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Dietary Management of Type 2 Diabetes
Resource Pack
Thames Valley Dietitian Forum
September 2019
Table of contents
Background…………………………………………………………………………………………………………. 5
Reviewing and updating………………………………………………………………………………………. 5
Decision tree…………….………………………………………………………………………………………… 6
Step 1: Referring to local structured education………………………………………………. 7
Step 2: Providing Diabetes UK booklets………………………………………………………….. 8
Step 3: Referring to local weight management services…………………………………… 9
Step 4: Weight loss resources………………………………………………………………………… 10
4.1 Low energy diets…………………..……………………………………………………………. 11
4.2 Low carbohydrate diets………………………………………………………………………. 13
4.3 Mediterranean-style diets………………………………………………………………….. 15
4.4 Low fat, healthy eating……………………………………………………………………….. 16
4.5 Intermittent fasting …………………………………………………………………………… 18
4.6 Low glycaemic index diets………………………………………………………………….. 19
Evidence review……….…………………………………………………………………………………………. 20
Low energy diets………………….…………………………………………………………….. 21
Low carbohydrate diets……………….……………………………………………………… 22
Mediterranean-style diets………………………………………………………………….. 25
Low fat, healthy eating……………………………………………………………………….. 26
Intermittent fasting …………………………………………………………………………… 27
Low glycaemic index diets…………………………………………………………………… 28
References………………………...……………………………………………………………………………….. 28
Appendix 1. Local structured education programmes…………………………………………. 33
Berkshire…………………………………………………………………………………………… 33
Buckinghamshire………………………………………………………………………………… 35
Frimley Health……………………………………………………………………………………. 36
Oxfordshire……………………………………………………………………………………….. 37
Appendix 2. Local weight management programmes………………………………………….. 38
Berkshire………………………………………………………………………………………… 38
Buckinghamshire…………………………………………………………………………….. 40
Dietary management of type 2 diabetes Page 2 of 40
TVDF resource pack. September 2019. Final v1
Frimley Health………………………………………………………………………………… 42
Oxfordshire………………………………………………………………………………………. 43
Appendix 3. Medication adjustment for low carbohydrate and low energy diets…. 45
Appendix 4. Medication adjustment for intermittent fasting……………………………….. 48
Appendix 5. Handouts with information about resources……………………………………. 49
Low energy diets………………….…………………………………………………………… 50
Low carbohydrate diets……………….……………………………………………………. 51
Mediterranean-style diets…………………………………………………………………. 52
Low fat, healthy eating……………………………………………………………………… 53
Intermittent fasting …………………………………………………………………………. 54
Members of Thames Valley Dietitian Forum………………………………………………………… 55
Supplement 1. Low carbohydrate diet
Supplement 2. Mediterranean-style diet
Dietary management of type 2 diabetes Page 3 of 40
TVDF resource pack. September 2019. Final v1
Abbreviations CER Continuous energy restriction CVD Cardiovascular disease GI Glycaemic index IF Intermittent fasting LCHF Low carbohydrate high fat LED Low energy diet MD Mediterranean diets MHRA Medicines and healthcare products regulatory agency NICE National institute for health and care excellence SACN Scientific advisory committee on nutrition SFA Saturated fatty acids TDR Total diet replacement TVDF Thames Valley dietitian forum VLED Very low energy diet This resource pack has been produced by the Thames Valley Strategic Clinical Network (TVSCN) Dietitian Forum on behalf of the TVSCN Diabetes Network. For further details about the TVSCN and/or this resource pack please contact Julia Coles, Senior Clinical Network Manager, TVSCN. Email: julia.coles1@nhs.net Dietary management of type 2 diabetes Page 4 of 40 TVDF resource pack. September 2019. Final v1
Background People with type 2 diabetes attempting to lose weight, improve glycaemic control and reduce their risk of cardiovascular disease (CVD) have a wide variety of dietary strategies to choose from, and it is essential that they receive evidence-based advice from health care professionals. The Thames Valley Dietitian Forum (TVDF) supports the view of Diabetes UK that there is an extensive variety of dietary strategies that have shown to be effective in type 2 diabetes1, and it is committed to offering individualised, evidence-based advice. Information is disseminated in many different ways; verbally, through resources such as diet sheets and books and digitally either online or through apps, although not all available advice has a robust evidence base. In order to ensure that people with diabetes are able to make informed choices about personal dietary strategies, the TVDF has formulated an evidence review for a selection of widely available resources, and this has been synthesised into recommendations supported by resources where applicable. A decision tree is provided for reference, and each action is supported with a description of available resources and how to access them. The full evidence base for all resources has been produced and is available to reinforce appropriate advice. Reviewing and updating New dietary resources are constantly being developed and disseminated, and the TVDF is committed to reviewing and updating the resource pack as necessary using the following protocol: The resource pack will be reviewed and updated at six-monthly intervals Any new resources will be submitted to the TVDF At least two dietitians from different areas will review the resource An evidence-based report will be compiled Following a positive report, the resource will be included in the next iteration of the resource pack Dietary management of type 2 diabetes Page 5 of 40 TVDF resource pack. September 2019. Final v1
Dietary management of type 2 diabetes: Decision tree
1 See page 6
2 See page 11
3 See page 12
4 See page 19
Dietary management of type 2 diabetes Page 6 of 40
TVDF resource pack. September 2019. Final v1Step 1: Referring to local structured education
Structured education is the foundation for effective self-management and is recommended by
NICE2 and by Diabetes UK1 at the time of diagnosis and with annual reinforcement. Details of
local available programmes, by region, can be found in Appendix 1, page 33:
Index to structured education programmes
Area Page
Berkshire:
Berkshire East……………………………………………………. 33
Berkshire West………………………………………………….. 34
Buckinghamshire……………………………………………………… 35
Frimley Health:
NE Hants & Farnham…………………………………………. 36
Surrey Heath……………………………………………………… 36
Oxfordshire……………………………………………………………… 37
A new national programme, Healthy Living for People with Type 2 Diabetes (HeLP Diabetes) will
be available from early 2020. HeLP Diabetes is an online self-management support programme
and accompanying structured education pathway for adults with type 2 diabetes and was
originally developed by a team at University College London (UCL). It provides information
about type 2 diabetes and its treatments, offers emotional support, and helps with adopting
and maintaining healthy behaviours (diet and physical activity). HeLP offers an alternative
means of accessing support alongside more traditional group based structured education
programmes, and is intended to increase access to these services.
More information is available at:
https://www.england.nhs.uk/diabetes/digital-innovations-to-support-diabetes-outcomes/help-
diabetes/
Dietary management of type 2 diabetes Page 7 of 40
TVDF resource pack. September 2019. Final v1Step 2: Providing Diabetes UK booklet For those who do not wish or are unable to attend local structured education groups and who have a BMI
Step 3: Signposting local weight management groups
Local weight management groups, which are free at the point of delivery, are available in the
Thames Valley. For details, please see Appendix 2, page 38.
Index to structured weight management programmes
Area Page
Berkshire:
Berkshire East………………………………………………… 38
Berkshire West………………………………………………… 39
Buckinghamshire 40
Frimley Health:
NE Hants & Farnham……………………………………… 42
Surrey Heath…………………………………………………… 42
Oxfordshire…………………………………………………………… 43
Dietary management of type 2 diabetes Page 9 of 40
TVDF resource pack. September 2019. Final v1Step 4: Offering weight loss advice
If local weight management services or groups are not available, or if people with type 2
diabetes are unwilling or unable to attend, individualised weight management advice can be
offered. It is best practice to ensure that all dietary support is evidence-based and conforms
with guidelines.
Evidence-based advice for weight loss in those with type 2 diabetes includes:
− low energy (calorie) diets
− low carbohydrate diets
− Mediterranean-style diets
− general healthy, low fat eating combined with a degree of energy restriction.
There is also more limited evidence to support the use of intermittent fasting. The full evidence
review of these diets is available on page 20. There are a variety of commonly available
resources to support these different strategies, and the range of resources recommended
below reflects the decision of the expert dietitian group, and is not necessarily exhaustive.
Those that have been considered are those that are commonly mentioned by people with
diabetes during consultations, although some frequently used resources are not included due
to insufficient evidence. Printable leaflets including a full list and brief description of each of the
recommended resources for each individual dietary strategy are available in Appendix 5, page
49.
Index to printable handouts
Dietary strategy Page
Low energy diets…………………………………………………………. 50
Low carbohydrate diets………………………………………………… 51
Mediterranean-style diets…………………………………………… 52
Low fat, healthy eating…………………………………………………. 53
Intermittent fasting……………………………………………………… 54
Dietary management of type 2 diabetes Page 10 of 40
TVDF resource pack. September 2019. Final v14.1 Low energy diets
Low energy diets typically provide 800-1200 kcal/day from food, meal replacement products (shakes, bars and soups) or a combination of the
two. The evidence review is available on page 21.
Total diet replacement
Recent studies such as the DiRECT and DROPLET trials used a short period (12-24 weeks) of total diet replacement (TDR) using formula foods,
followed by structured food reintroduction and weight management programmes. Although they have reported positive effects, it is important
to remember that these are structured behavioural interventions designed to maintain weight loss over the long-term, and not simply a short-
term intervention. At present, only Counterweight Plus (used in DiRECT) and the Cambridge Weight Plan (DROPLET) have a strong evidence
base. If people with type 2 diabetes wish to adopt a TDR strategy, this is as yet unavailable on the NHS, and they will need to self-fund.
Currently, the NHS is rolling out a TDR programme and this may be available in some areas in the near future. People adopting TDR require
proactive medication adjustment, see Appendix 3, page 45.
Name Description Cost Contact details
Counterweight Plus 12 weeks of TDR using branded products followed by Approximately £100 https://www.counterweight.org
food reintroduction and weight maintenance support per month
The 1:1 diet 12 weeks of TDR using branded shakes, bars and Approximately £50 https://www.one2onediet.com/abou
(Cambridge Weight soups followed by structured food reintroduction per week during t-us
Plan) under personal supervision of a counselllor TDR, then ~£30 pw
Lighter Life 8 weeks of TDR using branded Foodpacks (shakes, Approximately £70 https://www.lighterlife.com
bars, soups, pasta) followed by structured food per week during TDR
reintroduction. Both personal counsellors and groups
are offered
Optifast 8-12 weeks of TDR using branded shakes and soups Approximately £60 https://www.nestlehealthscience.co.
followed by food reintroduction per week uk/optifast/home
Dietary management of type 2 diabetes Page 11 of 40
TVDF resource pack. September 2019. Final v1Food based diets
Food-based low energy diets were used in most of the early studies, including UKPDS, but have fallen out of fashion recently with the
introduction of meal replacements. However evidence from these early studies indicate that they are effective. People choosing this strategy
are advised to monitor blood glucose levels and may require proactive medication adjustment, see Appendix 1. Recommended resources
include:
Name Description Cost Contact details
Diabetes UK online Online 1200 kcal/day, nutrient-dense diets that and Free https://www.diabetes.org.uk/guide-
energy-restricted diets are high in fruit and vegetables and dietary fibre and to-diabetes/enjoy-food/eating-with-
low in saturated fat. They offer 7-day menu plans diabetes/meal-plans
with recipes for both meat-eaters and vegetarians
Dietary management of type 2 diabetes Page 12 of 40
TVDF resource pack. September 2019. Final v14.2 Low carbohydrate diets There is no consensus on the definition of low carbohydrate diets, but a low a carbohydrate diet is usually assumed to provide
Low carb diabetes Cookbook authored by David Cavan £14.99 https://www.penguin.co.uk/books/111/1113968/the-
cookbook (diabetes consultant) and Emma Porter (Available at low-carb-diabetes-cookbook/9781785041402.html
(food writer and person with type 1 cheaper prices at
diabetes). Promoted as a method of Amazon)
managing type 1 diabetes and reversing
type 2 diabetes, although management of
type 2 diabetes is also included.
Recommends limiting carbohydrate
intake to 50-100g/day and provides
recipes and meal plans
Carbs and Cals/World Books and apps. These resources are Books £9.99 https://www.carbsandcals.com
Foods designed for those who wish to Apps £4.99
carbohydrate and calorie count. They are
not designed for stand-alone use, but are
useful for supporting a specific energy or
carbohydrate restriction
Low carbohydrate Diet sheet Free Available at the back of this resource pack
(4.3 Mediterranean-style diets The Mediterranean diet (MD) reflects the culinary traditions of people living in countries bordering the Mediterranean sea and is characterised by higher intakes of vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil. It is not, however, a licence to eat unlimited pasta, pizza and red wine. Mediterranean-style diets are supported by Diabetes UK and have an extensive evidence base, see page 25. Name Description Cost Contact details Diabetes UK online This provides simple advice about Free https://www.diabetes.org.uk/guide-to- Mediterranean meal choosing Mediterranean-style foods and diabetes/enjoy-food/eating-with-diabetes/meal- plan provides a 7-day menu plan with recipes. plans-/mediterranean Mediterranean-style Diet sheet Free Available at the back of this resource diet Dietary management of type 2 diabetes Page 15 of 40 TVDF resource pack. September 2019. Final v1
4.4 Low fat, healthy eating
These diets are recommended for the management of type 2 diabetes and for CVD risk reduction by most authorities, although an energy
restriction is required for those who would benefit from weight loss. This strategy has been widely used in research studies and the evidence
review is available on page 26.
Name Description Cost Contact details
NHS online weight A 12-week online plan incorporating Free https://www.nhs.uk/live-well/healthy-weight/start-
loss plan dietary advice, physical activity and the-nhs-weight-loss-plan/
behavioural strategies
British Heart A booklet including dietary advice, Free https://www.google.com/url?sa=t&rct=j&q=&esrc=s
Foundation ‘Facts not physical activity and behavioural support &source=web&cd=1&cad=rja&uact=8&ved=2ahUKE
Fads’ for weight loss wiMrpLh1NnjAhXkolwKHcgcBcAQFjAAegQIBBAC&url
=https%3A%2F%2Fwww.bhf.org.uk%2F~%2Fmedia%
2Ffiles%2Fpublications%2Fhealthy-eating-and-
drinking%2Fm2_facts_not_fads_weightv2.pdf&usg=
AOvVaw3m0kZLaDwZcbuWofw1ppyo
Diabetes UK online Online 1200-1800 kcal/day, nutrient- Free https://www.diabetes.org.uk/guide-to-
energy restricted dense diets that and are high in fruit and diabetes/enjoy-food/eating-with-diabetes/meal-
diets vegetables and dietary fibre and low in plans
saturated fat. They offer 7-day menu plans
with recipes for both meat-eaters and
vegetarians
Our Path QISMET approved online 12-week weight £90 for 3m https://www.ourpath.co.uk
management programme incorporating without tech
dietary advice, physical activity and support
behavioural support £180 for 3m with
tech support
Dietary management of type 2 diabetes Page 16 of 40
TVDF resource pack. September 2019. Final v1Carbs and Cals/World Books and apps. These resources are Books £9.99 https://www.carbsandcals.com
Foods designed for those who wish to Apps £4.99
carbohydrate and calorie count. They are
not designed for stand-alone use, but are
and useful for supporting a specific
carbohydrate or energy restriction
Dietary management of type 2 diabetes Page 17 of 40
TVDF resource pack. September 2019. Final v14.5 Intermittent fasting
Intermittent fasting includes restricting energy intake to 500-600 kcal for 2 days per week (often referred to as the 5:2 or Fast diet), alternate
day fasting or time-restricted eating which involves leaving a >12-hour window without food each day. There is limited evidence for people
with type 2 diabetes, although most studies report that these strategies are as effective as continuous energy restriction, see evidence review
on page 27. The greatest issue is that there is an increased risk of hypoglycaemia in people treated by insulin or sulfonylureas, and proactive
medication adjustment is required on fasting days, see Appendix 4, page 48.
Name Description Cost Contact details
The Fast Diet Book by Michael Mosley and Mimi Book available https://thefastdiet.co.uk
Spencer. This programme, also known as from Amazon
5:2 includes 5 days of normal eating and 2 ~£6.99
days fasting (500-600kcal) each week.
Available as either a book or online
programme
Carbs and Cals 5:2 Book and app by Chris Cheyette and Yello Book £9.99 https://www.carbsandcals.com
Balolia with pictorial food plans and App £4.99
recipes
The 2-day diet Book by Michele Harvie and Tony Howell. £12.99 https://www.penguin.co.uk/articles/2019/feb/why-
This version of 5:2 involves two the-2-day-diet-works.html
consecutive days of low-carb, high-protein
eating, and healthy Mediterranean style
eating the rest of the week.
Dietary management of type 2 diabetes Page 18 of 40
TVDF resource pack. September 2019. Final v14.6 Low glycaemic index diets Recent meta-analyses have confirmed that low GI diets have little or no effect on weight loss and only a small (but significant) effect on glycaemic control, see evidence review, page 31 for further details. For this reason, they are no longer recommended as a primary strategy for people with type 2 diabetes, although they may be useful for fine-tuning blood glucose control. Dietary management of type 2 diabetes Page 19 of 40 TVDF resource pack. September 2019. Final v1
Evidence review for resources
In order to ensure that people with diabetes are able to make informed choices about personal
dietary strategies, the TVDF has formulated an evidence review for a selection of widely
available resources. The resources were selected by dietitians working in the Thames Valley and
were those that were most frequently mentioned by people with type 2 diabetes during
consultations. The evidence has been restricted to studies in people with type 2 diabetes,
although where evidence is limited, e.g. intermittent fasting (5:2 diet) findings from the general
population have been discussed.
In each dietary category, an overview of the evidence-base is provided and each specific
resource within a category has then been assessed. A hierarchy of evidence has been used to
grade the evidence for each resource based on the methodology adopted by the Scientific
Advisory Committee on Nutrition (SACN)3:
• Adequate – a meta-analysis was performed on three or more randomised controlled
trials. Alternatively, a total of four or more studies were identified in the systematic
review and/or the update search; these consistently showed the same outcome
although a meta-analysis was not performed.
• Moderate – a meta-analysis was performed on three or more randomised controlled
trials. Alternatively, three or more randomised controlled trials were identified in the
systematic review and/or the update search, which consistently showed the same
outcome although a meta-analysis was not performed.
• Limited – three to four randomised controlled trials were identified and there was some
indication that the results were in the same direction, but no meta-analysis was
performed. However, the evidence may also have been considered limited if there were
a number of studies, but the biological plausibility was unclear, the methodology was
not precise or the exposures were heterogeneous.
• Inconsistent – the results from meta-analyses or pooled analyses are conflicting and it is
not possible to draw a conclusion.
• Insufficient – there are no meta-analyses and1. Low energy (calorie) diets Evidence grade: Adequate Low energy diets (LED) are defined as providing 800-1200 kcal/day4 and are typically composed of total diet replacement (TDR) using formula foods, a food-based diet or partial replacement (where one or two meals a day are replaced by formula foods). The evidence for both TDR and food-based diets are discussed below. It is important to note that very low energy diets (VLED), defined as providing approximately 600-800 kcal/day, are not currently recommended by NICE4 and have not been further considered here. 1.1 Total diet replacement Evidence grade: Adequate TDR provides the strongest evidence for the efficacy of low energy diets, with evidence of benefit in people with type 2 diabetes5,6. Two recent trials reported weight losses of ~10kg at one-year’s follow-up7,8. In addition, the DiRECT trial has reported diabetes remission rates of 46% at one year and 36% at two-years follow-up following a period of TDR7,9. The authors emphasise that this was a structured, behavioural intervention designed to maintain weight loss over the longer term, and the idea that TDR alone can be used as a quick fix for either weight loss or remission of type 2 diabetes is not supported by current evidence. Only Counterweight Plus (used in DiRECT7) and the Cambridge Plan (used in DROPLET8) have any direct evidence of effect, but there is little reason to suggest that other commercial providers would be inferior. 1.2 Food-based diets Evidence grade: Moderate The evidence for food-based LEDs is weaker than that for TDR, although a recent meta-analysis reports favourable outcomes for 800-1200kcal/day diets in people with type 2 diabetes10. In addition, a small local pilot study of 800-1000kcal/day has demonstrated significant weight loss and improvements in glycaemic control11. 1.2.1 The 8-week blood sugar diet (Online and book) Evidence grade: Insufficient This book is based on the success of the DiRECT trial and suggests that food can be used to replace the TDR stage which provides ~800kcal/day. However, the TDR phase of DiRECT lasted 12-20 weeks, and there are no studies specifically investigating an 8-week period of restriction. Dietary management of type 2 diabetes Page 21 of 40 TVDF resource pack. September 2019. Final v1
In addition, although this book provides tips for maintenance of weight loss, it does not include
a structured maintenance programme.
1.2.2 The Fast 800 (online and book)
Evidence grade: Insufficient
This programme is a combination of 800kcal/day with a 5:2 diet and a weight maintenance plan
based on a Mediterranean diet. Although well-written and easy to use (especially the online
plan with recipes), there is limited evidence to support intermittent fasting in type 2 diabetes
(see section below) and no study has investigated this combination of strategies for efficacy.
1.2.3 Carbs and cals VLED meal plans and recipes
Evidence grade: Insufficient
This book suggests meal plans and recipes that can be used to provide ~800kcal/day. No
recommendations are made about the period of restriction (30-day meal plans are provided) or
food reintroduction at the end of the restriction phase.
2. Low carbohydrate diets
Evidence grade: Adequate
Low carbohydrate (1.1 NHS online low carb programme Evidence grade: Adequate for low carbohydrate component Although there is evidence of efficacy from low carbohydrate diet studies, only two studies have reported outcomes for online low carbohydrate programmes. Both studies report positive outcomes in terms of improvements in glycaemic control, weight loss and reductions in diabetes medication22,23. However, firm conclusions are limited by the lack of evidence from large randomised controlled trials of online interventions and the fact that of the two studies mentioned above, one study was an audit without a comparator group 22 and the other was a small study (n=25) using a very low carbohydrate ketogenic diet (20-50g carbohydrate/day) as the intervention23. 1.2 Diabetes UK online low carb meal plan Evidence grade: See comments above 1.4 Diet Doctor online programme Evidence grade: Insufficient Despite general evidence that carbohydrate restriction is effective, no head-to-head studies have investigated the three levels of restriction recommended in this programme (Low/keto:
A low carbohydrate, high fat (LCHF) ketogenic diet is recommended here and there is little evidence of efficacy of this strategy in people with type 2 diabetes. Although there is no agreed definition for a low carbohydrate ketogenic diet, it is generally assumed that ketosis occurs at intakes of
1.7 Public Health Collaboration resources Evidence grade: Insufficient The advice published online by the Public Health Collaboration (PHC) states that the carbohydrate restriction for weight loss should be
4. General advice/low fat/healthy eating 4.1 Carbs and Cals counter book/app and Carbs and Cals World Foods Evidence grade: Insufficient for carbohydrate counting, adequate for calorie counting/energy restriction The efficacy of carbohydrate counting on weight loss in people with type 2 diabetes is largely unknown. One small study investigating the effects on glycaemia in people taking insulin reported that it is as effective in reducing HbA1c as a simple algorithm 45. However, although monitoring carbohydrate intake whether by use of exchanges, portions or experience-based estimation remains a key strategy in achieving glycaemic control in people with type 2 diabetes, there are no studies investigating its role in weight loss. Counting calories and energy restriction are effective for weight loss46. 4.2 NHS online Weight loss plan Evidence grade: Adequate A 12-week online energy-restricted diet and exercise programme including behavioural strategies. This combination of strategies is effective for weight loss in people with type 2 diabetes46. 4.3 Diabetes UK online energy-restricted diets Evidence grade: Adequate Diabetes UK offer online 1200 and 1500kcal/day diets for men and women and include vegetarian options. In addition the web-site offers behavioural tips for weight loss and this approach is effective for people with type 2 diabetes45. 4.4 OurPath online weight loss programme Evidence grade: Adequate A 12-week online diet and exercise programme endorsed by the NHS. Individuals are provided with a handbook, smart scales and optional activity tracker and are supported by a personal health coach. Behavioural strategies are integral to the programme. After the 12 week intervention period, a weight loss maintenance programme is offered. This combination of strategies is effective for weight loss in people with type 2 diabetes46. 4.3 BHF Facts not fads Evidence grade: Adequate Dietary management of type 2 diabetes Page 26 of 40 TVDF resource pack. September 2019. Final v1
The BHF guide is based on the concept of healthy eating and the Eatwell Guide. It includes
guidance for energy restriction and includes behavioural strategies. This combination of
strategies is effective for weight loss in people with type 2 diabetes46.
4.3 MyFitnessPal app
Evidence grade: Insufficient
It is widely acknowledged that self-monitoring supports weight loss in the general
population47,48, although there is little evidence for those with type 2 diabetes. Electronic
devices such as MyFitnessPal are a means of self-monitoring, although it has been reported that
it tends to underestimate intake49,50. A study specifically investigating its use for weight loss in
primary care reported that it neither supported weight loss nor had any effect compared to
usual care51.
5. Intermittent fasting (IF)
Evidence grade: Limited
Intermittent fasting has been sub-divided into restricted intake (usually 500-600kcal/day) on 2
days each week (often called the 5:2 or Fast diet), alternate day fasting where intake is
restricted on alternate days or time-restricted eating where meals are typically restricted to an
8-hour window52. A recent review has reported that IF is as effective as continuous energy
restriction (CER) for weight loss in the general population, although the authors state in their
conclusion that ‘reaching a firm conclusion on the relative merits of IF is not possible without
further studies with appropriate controls’53. One randomised controlled trial in people with
type 2 diabetes reported no difference between IF and CER at one and two-year’s follow-up54,55,
although both strategies were effective for weight loss and improving glycaemic control.
5.1 The Fast Diet
Evidence grade: Limited
See above comments
5.2 Carbs and Cals 5:2 diet photos
Evidence grade: Limited
See above comments
Dietary management of type 2 diabetes Page 27 of 40
TVDF resource pack. September 2019. Final v15.3 The 2-day diet
Evidence grade: Limited
See above comments
6. Low GI diets
Evidence grade: Inconsistent
Low GI diets have been recommended as a first-line strategy for managing type 2 diabetes,
although they have no significant effect on weight loss56,57. In the past, low Gl diets have been
reported to lower HbA1c by 4-6mmol/mol (0.4–0.5%), although these results may be
confounded by differences in fibre content and effects of body weight between low and high GI
diets. However, more recent meta-analyses have reported more modest effects of 2-
3mmol/mol (0.2-0.3%)58,59 and low GI diets are no longer recommended by Diabetes UK for
weight loss although they may be useful for fine-tuning glycaemic control1.
References
1. Diabetes UK. Evidence-based nutrition guidelines for the prevention and management
of diabetes. March 2018. Available at: https://diabetes-resources-production.s3.eu-
west-1.amazonaws.com/resources-s3/2018-03/1373_Nutrition%20guidelines_0.pdf
2. National Institute for Health and Care Excellence. Type 2 diabetes in adults:
management [NG 28]. London, NICE;2015.
3. Scientific Advisory Committee on Nutrition and Health. Carbohydrates and health. SACN.
2015; London: TSO.
4. National Institute for Health and Care Excellence. Obesity: Identification, assessment and
management of overweight and obesity in children, young people and adults (CG189).
NICE, London; 2014
5. Leslie WS, Taylor R, Harris L, Lean ME. Weight losses with low-energy formula diets in
obese patients with and without type 2 diabetes: systematic review and meta-analysis.
Int J Obes (Lond). 2017;41:96-101.
6. Sellahewa L, Khan C, Lakkunarajah S, Idris I. A Systematic Review of Evidence on the Use
of Very Low Calorie Diets in People with Diabetes. Curr Diabetes Rev. 2017;13(1):35-46.
7. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C,
Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson
AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Stefanetti R, Trenell M, Welsh P,
Kean S, Ford I, McConnachie A, Sattar N, Taylor R. Primary care-led weight management
for remission of type 2 diabetes: (DiRECT): an open-label, cluster-randomised trial.
Lancet.
2018;391:541-551.
8. Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, Jebb SA. Doctor Referral
of Overweight People to Low Energy total diet replacement Treatment (DROPLET):
pragmatic randomised controlled trial. BMJ. 2018;362:k3760.
Dietary management of type 2 diabetes Page 28 of 40
TVDF resource pack. September 2019. Final v19. Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C,
Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, Rodrigues AM, Rehackova L, Adamson
AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Welsh P, Kean S, Ford I,
McConnachie A, Messow CM, Sattar N, Taylor R. Durability of a primary care-led weight-
management intervention for remission of type 2 diabetes: 2-year results of the DiRECT
open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344-355.
10. Kloecker DE, Zaccardi F, Baldry E, Davies MJ, Khunti K, Webb DR. Efficacy of low- and
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TVDF resource pack. September 2019. Final v1Appendix 1
Structured education programmes
Berkshire
Area Programme name Description of programme Contact details
Berkshire East DEAL* The course is 2 x 3 hours sessions. Referral via DXS to
Session 1: Bks-tr.DiabetesCentre@nhs.net
• What is Type 2 Diabetes and what it means to
you and your family
or send completed referral form by post to:
• Management of diabetes and the medications
used
• How to monitor your blood glucose levels and Bookings Co-Ordinators
what the different blood results mean Diabetes Centre
• Understanding the long term complications, King Edward VII Hospital
with advice on prevention and treatment St. Leonard’s Road
• Looking after your health and what health
checks you are entitled to
Windsor
• Employment and driving advice Berkshire
SL4 3DP
Session 2:
• What foods affect your diabetes
• What and how much to eat
• How to read food labels and what to look out
for
• Advice on eating out and celebrations
• How to change food behaviours
• How to manage your weight
• Goal planning
Dietary management of type 2 diabetes Page 33 of 40
TVDF resource pack. September 2019. Final v1You can also read
