Updated nutritional guidelines for people with diabetes

Nutrition plays a pivotal role in the prevention and management of diabetes

Diabetes is becoming an increasingly alarming public health challenge. In Vietnam, the burden of diabetes continues to rise, with projections estimating that by 2025, more than 7 million people will be diagnosed with the condition. The challenge extends beyond daily glycemic control to the heightened risk of serious complications affecting the cardiovascular system, kidneys, and eyes, all of which significantly impair quality of life.

In response, global treatment guidelines have continuously evolved, with medical nutrition therapy increasingly recognized as a foundational pillar. The latest scientific evidence, as consolidated by the American Diabetes Association (ADA), highlights that the key to effective management lies in adopting flexible, personalized dietary patterns that prioritize food quality rather than strict dietary restrictions as previously emphasized.

The role of nutrition in glycemic management

Before exploring specific recommendations, it is essential to understand why nutrition is considered a cornerstone of non-pharmacological therapy and an indispensable component of diabetes management protocols.

Direct impact on blood glucose control

Nutrition has the most immediate and profound influence on blood glucose levels, particularly in the postprandial state. The type and quantity of carbohydrates, along with the presence of fiber, protein, and fat in a meal, determine both the rate and magnitude of glycemic response. Therefore, a scientifically structured diet serves as a frontline tool to achieve glycemic targets—both fasting and postprandial—while supporting improvements in HbA1c levels.

Reduction of cardiovascular risk factors

Nutrition helps reduce cardiovascular risk factors in people with diabetes

Diabetes and cardiovascular disease are often considered “dangerous companions.” Individuals with diabetes face a significantly higher risk of cardiovascular complications compared to the general population, and these complications remain the leading cause of mortality in this group. An optimized dietary pattern—such as prioritizing unsaturated fats (MUFA, PUFA) while limiting sodium intake—can directly improve lipid profiles (lowering LDL cholesterol and triglycerides) and support blood pressure control. This, in turn, reduces the risk of atherosclerosis and other cardiovascular events.

Improving insulin sensitivity through weight management

In type 2 diabetes, the core pathophysiological mechanism is insulin resistance, meaning that the body’s cells no longer respond effectively to insulin signals. This condition is closely associated with overweight and obesity, particularly visceral fat accumulation. Nutrition plays a central role in weight management. Research has shown that even a modest weight loss of 5–10% through a well-structured diet can significantly improve insulin sensitivity, enabling the body to utilize glucose more efficiently and, in some cases, reduce the need for medication.

Evolution of dietary patterns for diabetes in the latest guidelines

The most significant shift in recent guidelines is the recognition that there is no “one-size-fits-all” nutritional approach. Modern strategies have moved away from rigid rules toward selecting individualized dietary patterns tailored to each patient.

Traditional approach: Focus on “counting” and “elimination”

Nutrition models for diabetes focus on quality over quantity

For decades, nutritional approaches for diabetes were primarily based on a quantitative model. The core of this approach was strict carbohydrate counting and the use of food exchange lists to precisely control glucose intake. While scientifically grounded, this method often created a mindset of “restriction” and “fear” toward many food groups, particularly fruits and carbohydrate-rich foods.

As a result, patients frequently faced a significant psychological burden, perceiving their diet as limited and monotonous. This not only reduced quality of life and created social barriers around eating, but also posed a risk of micronutrient deficiencies due to the unnecessary exclusion of healthy foods. More importantly, the rigidity of this approach made it difficult to sustain in the long term, especially within diverse and culturally rich dietary environments.

New guidelines: Focus on “patterns” and “quality”

Recent scientific evidence has driven a paradigm shift in nutritional management. The latest 2024 guidelines from the American Diabetes Association clearly emphasize that there is no single ideal macronutrient ratio suitable for everyone. The focus has shifted away from controlling individual nutrients toward building overall healthy eating patterns.

Accordingly, the ADA highlights that multiple dietary patterns have proven effective, such as the Mediterranean diet, the DASH diet, and plant-based diets. This shift provides substantial flexibility, empowering patients and healthcare professionals to collaboratively select a dietary model that aligns with individual preferences, cultural context, economic conditions, and comorbidities. This approach moves from “restriction” to “informed choice,” improving long-term adherence and leading to more sustainable clinical outcomes.

Updated nutritional principles in diabetes management

This modern approach is grounded in core scientific principles, emphasizing the quality of each macronutrient group rather than merely the quantity.

Carbohydrates: Quality matters more than quantity

Prioritize carbohydrates with a low glycemic index

Rather than simply counting carbohydrate grams, current guidelines emphasize selecting high-quality carbohydrates that are rich in fiber, minimally processed, and have a low glycemic index (GI). These carbohydrates are absorbed more slowly, helping to flatten post-meal glucose spikes and improve insulin sensitivity. Fiber plays a strategic role. The ADA recommends at least 14 g of fiber per 1000 kcal intake, with emphasis on soluble fiber to improve lipid profiles and glycemic control². Therefore, whole grains (brown rice, oats), legumes, and whole fruits are encouraged, while added sugars and refined grains should be minimized.

Protein and fat: Flexibility in selection and ratio

Protein continues to play an important role in increasing satiety, slowing carbohydrate absorption, and maintaining muscle mass. There is no single ideal protein ratio for everyone, but ensuring adequate intake (about 15–20% of total energy) is necessary. The guidelines emphasize prioritizing lean protein sources such as fish, poultry, and especially plant-based proteins.

For fats, the focus is on quality rather than quantity. ADA recommends replacing saturated fats and trans fats with unsaturated fats (MUFA, PUFA) to improve lipid profiles and reduce cardiovascular risk. Sources such as olive oil, avocado, nuts, and fatty fish (rich in Omega-3) are strongly encouraged in the diet of people with diabetes.

Sodium intake control

Sodium is another factor that must be strictly controlled, as people with diabetes are at very high risk of hypertension and cardiovascular diseases. ADA recommends limiting sodium intake to below 2300 mg per day. Achieving this requires minimizing processed foods, canned products, and developing the habit of carefully reading nutrition labels to avoid foods high in hidden sodium.

Guidance on building a personalized nutrition plan for people with diabetes

Applying the above principles in daily life can be achieved through simple tools and practical strategies.

Choosing an appropriate eating pattern

The American Diabetes Association (ADA) emphasizes that the “best diet” is the eating pattern that a patient can follow sustainably over the long term. Based on scientific evidence, individuals can choose one of the following dietary models, under the guidance of a nutrition professional to suit their preferences, cultural context, and comorbid conditions:

–       Mediterranean Diet: This model not only focuses on a high intake of vegetables, fruits, whole grains, and legumes, but also emphasizes the use of extra virgin olive oil as the primary fat source and prioritizes protein from fish and seafood. The Mediterranean diet has been demonstrated in numerous clinical studies to improve cardiovascular health (reducing LDL cholesterol and inflammation), which is an extremely important goal for people with diabetes⁵.

–       DASH diet (Dietary Approaches to Stop Hypertension): Originally designed to control high blood pressure, this model focuses on reducing sodium intake and increasing key minerals such as potassium, magnesium, and calcium from vegetables, fruits, and low-fat dairy products. Since people with diabetes have a high risk of hypertension, this is also a preferred option, offering dual benefits for both blood glucose and blood pressure control.

–   Plant-based diet: This model emphasizes maximizing plant-based foods while limiting or eliminating animal products. This dietary pattern is associated with improved insulin sensitivity, effective weight management, and provides a rich source of dietary fiber, which is highly beneficial for blood glucose control and gut health.

Visual Tool: The “Diabetes Plate Method

“The Plate Method” – A simple approach to portion control for people with diabetes

To simplify the application of complex nutritional principles into daily practice, the “Diabetes Plate Method” is recommended by the ADA as a visual educational tool. It helps control portion sizes and balance nutrients without the need for weighing or complicated calculations. A standard plate (about 23 cm in diameter) is divided into sections based on clear scientific rationale:

–   1/2 of the plate: Non-starchy vegetables.

This largest portion provides a high amount of fiber, vitamins, and minerals while being very low in calories and carbohydrates. It helps promote satiety, slows the absorption of glucose from other foods, and has minimal impact on blood sugar levels.

–   1/4 of the plate: Lean protein sources.

Lean protein sources (such as fish, skinless poultry, tofu, and eggs) help maintain muscle mass, increase satiety, and have minimal impact on blood glucose. The presence of protein also slows overall digestion, contributing to a more gradual rise in blood sugar levels.

–   1/4 of the plate: High-quality carbohydrates.

This portion provides essential energy while being strictly controlled in quantity. Priority should be given to fiber-rich, low glycemic index (GI) carbohydrates such as brown rice, sweet potatoes, oats, and legumes. These ensure a slow and steady release of energy, helping maintain stable blood glucose levels and prevent postprandial spikes.

Although the “Plate Method” is highly effective for main meals, preparing scientifically balanced snacks or quick meal replacements that still adhere to these principles can be challenging. To support convenient adherence to these complex nutritional recommendations, medical nutrition solutions developed based on scientific research are considered effective options for people with diabetes. Glucare Gold nutritional supplement (collectively referred to as “Glucare Gold”), developed by Nutricare in collaboration with the Nutricare Medical Nutrition Institute – USA (NMNI-USA), is an example of this approach.

Glucare Gold incorporates a slow-digesting carbohydrate system, including Isomaltulose and Erythritol, both of which have a low glycemic index and have been clinically validated. This mechanism supports gradual energy release, thereby “flattening” the postprandial blood glucose curve and preventing sudden glucose spikes—meeting a primary goal in diabetes management.

In addition, the formula is supplemented with soluble fiber (FOS/Inulin), which functions as a prebiotic to nourish a healthy gut microbiota—an element that has been scientifically linked to improved insulin sensitivity. With a comprehensive nutritional profile of 56 essential nutrients, including easily absorbed whey protein and plant-based protein, Glucare Gold is not only a snack but also a nutritional solution that supports stable blood glucose control and enhances overall health.

Conclusion

Recent updates in nutritional guidelines for people with diabetes reflect a significant shift—from rule-based treatment toward precision medicine and personalized interventions. Nutrition is no longer a static set of instructions, but rather a dynamic therapeutic tool that can be adjusted and optimized based on the latest scientific evidence.

Focusing on carbohydrate quality, fat composition, and overall dietary patterns highlights that the goal is not only to stabilize blood glucose, but also to protect cardiovascular health and improve long-term clinical outcomes. Applying these principles, with the support of healthcare professionals, represents the most scientific and sustainable approach to making nutrition a powerful ally in the long-term management of diabetes.