Chinese Guidelines for Medical Nutrition Therapy for Patients with Diabetes (2022 Edition).

Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutri-tion, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT.

Exploring the therapeutic potential of functional foods for diabetes: A bibliometric analysis and scientific mapping.

The incidence of diabetes is increasingly becoming a global health burden. Meanwhile, in recent years, functional foods have been intensively investigated for diabetes management. These foods provide health benefits due to their bioactive compounds that enhance the metabolism and lower the risk of chronic diseases, such as diabetes. The aim of this study was to explore the keywords, countries/territories, publication numbers, institutions, authors, and journals associated with functional foods for the management of diabetes using a comprehensive bibliometric analysis method. Scopus database was used to compile the information, followed by VOSviewer for comprehensive bibliometric data analysis. A total of 1,226 Scopus articles that met the inclusion criteria were analyzed. The results showed that the greatest expansion in research occurred in 2012, and China was identified as the most productive nation in this field. In addition, Food and Function was found as the most recognized journal in this area, and Singh, R.B. as well as Zengin, G. made the greatest contribution. The bibliometric data also illustrated several mechanisms of functional foods for diabetes management, including antioxidant activity, effect on the gastrointestinal microbiomes, and inhibitor α-amylase. These results underscore the immense potential of functional foods in the diabetes management and provide guidance for future research on this subject.

Nutrition: Chronic Disease Management.

Dietary modifications can help to prevent and manage many chronic diseases. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets emphasize consumption of fruits and vegetables while reducing intake of red meat. These diets are supported by well-established evidence for patients with cardiovascular disease and hypertension, respectively. Whole-food, plant-based diets have been shown to result in reduced body weight, lower A1c levels, and decreased insulin resistance in patients with diabetes. Patients with diabetes and hypertension should adhere to a heart-healthy diet, such as the DASH diet. For patients with diabetes and at risk of diabetes, key nutritional recommendations include emphasizing intake of nonstarchy vegetables, minimizing intake of added sugars and refined grains, and choosing whole foods instead of processed foods. The Dietary Guidelines for Americans, 2020-2025 recommend that adults limit sodium intake to less than 2,300 mg/day. Patients with chronic kidney or liver disease should follow sodium restriction and protein intake guidelines. Patients with irritable bowel syndrome should follow a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet with fiber supplementation. For patients with gastrointestinal symptoms, fiber can effectively manage constipation and stool irregularity. Probiotic supplements or foods can be useful for digestive problems.

Produce Prescriptions Sound Good, but Data to Support Them Are Lacking-That Could Soon Change.

This Medical News article discusses research initiatives to support produce prescriptions and other "food is medicine" nutrition programs in health care settings.

Ontology-based decision support systems for diabetes nutrition therapy: A systematic literature review.

Diabetes is a non-communicable disease that has reached epidemic proportions, affecting 537 million people globally. Artificial Intelligence can support patients or clinicians in diabetes nutrition therapy - the first medical therapy in most cases of Type 1 and Type 2 diabetes. In particular, ontology-based recommender and decision support systems can deliver a computable representation of experts' knowledge, thus delivering patient-tailored nutritional recommendations or supporting clinical personnel in identifying the most suitable diet. This work proposes a systematic literature review of the domain ontologies describing diabetes in such systems, identifying their underlying conceptualizations, the users targeted by the systems, the type(s) of diabetes tackled, and the nutritional recommendations provided. This review also delves into the structure of the domain ontologies, highlighting several aspects that may hinder (or foster) their adoption in recommender and decision support systems for diabetes nutrition therapy. The results of this review process allow to underline how recommendations are formulated and the role of clinical experts in developing domain ontologies, outlining the research trends characterizing this research area. The results also allow for identifying research directions that can foster a preeminent role for clinical experts and clinical guidelines in a cooperative effort to make ontologies more interoperable - thus enabling them to play a significant role in the decision-making processes about diabetes nutrition therapy.

Time matters: an insight into the relationship between chrononutrition and diabetes.

Chrononutrition is a branch of chronobiology that evaluates nutrients and the pathways implicated in their regulation in accordance with circadian rhythms. Sleep deprivation and disturbances have been strongly associated with the progression of different metabolic alterations, and the time of food intake plays a fundamental role in maintaining metabolic homeostasis. It has been demonstrated that not only the components of food are important, but quantity and quality are also crucial elements of a healthy eating pattern. Chrononutrition is an emerging tool that could help improve dietary interventions beyond those derived from consuming an adequate amount of each nutrient. Diabetes is a complex endocrine pathology characterized by sustained hyperglycemia. Dietary changes are a key component in obtaining adequate control and preventing long-term complications. Recent studies emphasize the use of chrononutrition and its components as a novel dietary intervention that could improve metabolic control. The use of chrononutrition as a dietary intervention is faced with challenges such as the presence of gaps in the literature that limit its implementation. This emphasizes the imperative need for additional research that can lead to an evidence-based use of this intervention.

Evaluation of a Produce Prescription Program for Patients With Diabetes: A Longitudinal Analysis of Glycemic Control.

OBJECTIVE: Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes. RESEARCH DESIGN AND METHODS: Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar control participants from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time. RESULTS: At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI -0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; -0.12, 7.82), DBP (-0.82 mmHg; -2.42, 0.79), or BMI (-0.22 kg/m2; -1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively. CONCLUSIONS: A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control.

Ciclo de charlas: Envejecimiento activo y salud de las personas mayores. Sexto Encuentro. Programa para las Personas con Diabetes de la Provincia de Buenos Aires

En este encuentro, Gabriela Medek, médica especialista en Medicina Interna, Diabetes y Obesidad y asesora técnica del Programa para las Personas con Diabetes de la Provincia de Buenos Aires, desarrolla los siguientes temas vinculados a la Diabetes Mellitus tipo 2 en los adultos mayores: Diabetes un pandemia en aumento; Prevalencia a nivel mundial; Incidencia según grupo etario; Impacto a nivel mundial; Prevalencia en Argentina; Crecimiento de la pandemia de la Obesidad; Obesidad como factor de riesgo de Diabetes; Atención eficaz: características; Importancia del Primer Nivel de Atención; Definición de Diabetes Mellitus (DM); Valores de glucemia: normal, prediabetes, diabetes; Criterios de diagnóstico; Prueba de Tolerancia Oral a la Glucosa: interpretación; Clasificación de la DM; Diabetes tipo 2 en adulto mayor; DM tipo 2: descripción y características; Criterios para las pruebas de diabetes o prediabetes en adultos asintomáticos; DM: síntomas; Diferencias entre DM tipo 1 y 2; Complicaciones: hiperglucemia e hipoglucemia; Complicaciones crónicas; Importancia del enfoque multidisciplinario; Prevención primaria, secundaria y terciaria; Educación terapéutica diabetológica; Recomendaciones sobre el estilo de vida y alimentación saludable; Tratamiento farmacológico para DM tipo 2; Antidiabéticos orales; Metformina; Insulinoterapia en DM tipo 2; Análogos de la Insulina de acción lenta vs. Insulina NPH; Parámetros del control glucémico. Controles periódicos y Vacunación.

Effects of non-essential protein on D-glucose to control diabetes: DFT approach.

Diabetes is a disease found in every 1 out of 4 people in the world. The glucose molecule is one of the sources of energy in the body and the lack of the digestion of glucose causes diabetes type 1 and type 2. Arginine and cysteine are nonessential amino acids that contain sulfur and help maintain the metabolisms of humans. We explored the glucose-arginine (Glc-arg) and glucose-cysteine (Glc-cys) molecules by finding their structural properties, electronic properties, chemical reactivity, mechanical strength, and transport properties because these non-essential amino acid molecules inhibit glucose-stimulated insulin secretion. Density functional theory (DFT) has been implemented to study all the properties of Glc-arg and Glc-cys using SIESTA software. Glucose-arginine (Glc-arg) inhibits a large percentage of glucose secretion and shows high chemical reactivity.

Dietary interventions on the prevention and management of diabetes in post-kidney transplantation - A systematic review.

Post-transplant diabetes mellitus is associated with long-term immunosuppression and weight gain, and is related to an increased risk of cardiovascular disease, accelerated loss of graft and increased mortality. There is an absence of strong evidence-based dietary guidelines for the prevention and management of post-transplant diabetes mellitus in kidney transplant recipients. The aim of this study was to systematically review all dietary evidence for kidney transplant recipients on clinical outcomes relating to diabetes, patient-reported outcomes and economic outcomes. A comprehensive literature search was conducted in August 2020 using the databases Medline, Embase, CENTRAL and CINAHL. Studies were critically appraised using Cochrane risk of bias tools and GRADE. A total of 12 studies and 1928 participants were included. Four papers focused on diet and exercise, one paper on diet only, two papers on magnesium supplementation, one paper on magnesium and fibre intake, two papers on Mediterranean diet, one paper on marine n-3 fatty acid supplementation and one paper on fruit and vegetable intake. There were no significant effects on outcomes relating to dietary counselling, magnesium supplementation, magnesium and fibre intake or marine n-3 fatty acid supplementation. Low-quality evidence supports the Mediterranean diet in reducing the risk of post-transplant diabetes mellitus and fasting plasma glucose levels. Low-quality evidence suggests vegetable intake being associated with a lower risk of post-transplant diabetes mellitus. This review demonstrates limited evidence for dietary interventions in the prevention and management of diabetes in post-kidney transplantation. The findings suggest that further high-quality research with robust study designs is required.

Fascículo 1: protocolos de uso do guia alimentar para a população brasileira na orientação alimentar de pessoas adultas com obesidade, hipertensão arterial e diabetes mellitus: bases teóricas e metodológicas - versão preliminar / Issue 1: protocols for the use of the food guide for the Brazilian population in the dietary guidance of adults with obesity, arterial hypertension and diabetes mellitus: theoretical and methodological bases - preliminary version

Este é o primeiro fascículo da série intitulada "Protocolos de Uso do Guia Alimentar para a População Brasileira na orientação alimentar de pessoas adultas com obesidade, hipertensão arterial e diabetes mellitus". Um conjunto de três protocolos compõe essa série que foi elaborada com a finalidade de disseminar as recomendações do Guia Alimentar para a População Brasileira e instrumentalizar a orientação alimentar individualizada pelos profissionais da Atenção Primária à Saúde (APS). O presente fascículo apresenta a base teórica e metodológica utilizada para a construção de cada protocolo, a partir das recomendações do Guia Alimentar adaptadas ao contexto de cada doença.

'Old Is Gold': How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management.

Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families struggle to find ways to provide nutritious, yet attractive, food with a low glycemic index (GI). India is one of the oldest continuous civilizations with a rich and diverse cultural and culinary heritage. Traditional dietary practices, including the centuries-old 'Thali' (meaning plate) concept, emphasize combinations (grains, lentils, vegetables, dairy, spices, prebiotics and probiotics, and fats) of local, seasonal, and predominantly plant-based ingredients. These practices ensure that all of the necessary food groups are provided and fit well with current evidence-based recommendations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 Guidelines. Techniques for the preparation, cooking, and preservation of food further impact the GI and nutrient availability. These practices benefit nutrient density, diet diversity, and palatability and thus improve adherence to meal plans and glycemic control. This narrative review describes the ancient wisdom, food composition, and culinary practices from across India which are still valuable today. These may be of benefit worldwide to improve glycemic control as well as quality of life, especially in PwD.

Coffee Bioactive N-Methylpyridinium Attenuates Tumor Necrosis Factor (TNF)-α-Mediated Insulin Resistance and Inflammation in Human Adipocytes.

Although coffee consumption has been historically associated with negative health outcomes, recent evidence suggests a lower risk of metabolic syndrome, obesity and diabetes among regular coffee drinkers. Among the plethora of minor organic compounds assessed as potential mediators of coffee health benefits, trigonelline and its pyrolysis product N-methylpyridinium (NMP) were preliminary shown to promote glucose uptake and exert anti-adipogenic properties. Against this background, we aimed at characterizing the effects of trigonelline and NMP in inflamed and dysfunctional human adipocytes. Human Simpson-Golabi-Behmel syndrome (SGBS) adipocytes were treated with NMP or, for comparison, trigonelline, for 5 h before stimulation with tumor necrosis factor (TNF)-α. NMP at concentrations as low as 1 µmol/L reduced the stimulated expression of several pro-inflammatory mediators, including C-C Motif chemokine ligand (CCL)-2, C-X-C Motif chemokine ligand (CXCL)-10, and intercellular adhesion Molecule (ICAM)-1, but left the induction of prostaglandin G/H synthase (PTGS)2, interleukin (IL)-1ß, and colony stimulating factor (CSF)1 unaffected. Furthermore, NMP restored the downregulated expression of adiponectin (ADIPOQ). These effects were functionally associated with downregulation of the adhesion of monocytes to inflamed adipocytes. Under the same conditions, NMP also reversed the TNF-α-mediated suppression of insulin-stimulated Ser473 Akt phosphorylation and attenuated the induction of TNF-α-stimulated lipolysis restoring cell fat content. In an attempt to preliminarily explore the underlying mechanisms of its action, we show that NMP restores the expression of the master regulator of adipocyte differentiation peroxisome proliferator-activated receptor (PPAR)γ and downregulates activation of the pro-inflammatory mitogen-activated protein jun N-terminal kinase (JNK). In conclusion, NMP reduces adipose dysfunction in pro-inflammatory activated adipocytes. These data suggest that bioactive NMP in coffee may improve the inflammatory and dysmetabolic milieu associated with obesity.

Bioactive Peptides as Potential Nutraceuticals for Diabetes Therapy: A Comprehensive Review.

Diabetes mellitus is a major public health concern associated with high mortality and reduced life expectancy. The alarming rise in the prevalence of diabetes is linked to several factors including sedentary lifestyle and unhealthy diet. Nutritional intervention and increased physical activity could significantly contribute to bringing this under control. Food-derived bioactive peptides and protein hydrolysates have been associated with a number health benefits. Several peptides with antidiabetic potential have been identified that could decrease blood glucose level, improve insulin uptake and inhibit key enzymes involved in the development and progression of diabetes. Dietary proteins, from a wide range of food, are rich sources of antidiabetic peptides. Thus, there are a number of benefits in studying peptides obtained from food sources to develop nutraceuticals. A deeper understanding of the underlying molecular mechanisms of these peptides will assist in the development of new peptide-based therapeutics. Despite this, a comprehensive analysis of the antidiabetic properties of bioactive peptides derived from various food sources is still lacking. Here, we review the recent literature on food-derived bioactive peptides possessing antidiabetic activity. The focus is on the effectiveness of these peptides as evidenced by in vitro and in vivo studies. Finally, we discuss future prospects of peptide-based drugs for the treatment of diabetes.

The Mediterranean diet and health: a comprehensive overview.

The Mediterranean diet (MedDiet), one of the most studied and well-known dietary patterns worldwide, has been associated with a wide range of benefits for health. In the present narrative review, we aimed to provide a comprehensive overview of the current knowledge on the relation of the MedDiet to important health outcomes, considering both observational and intervention studies with both risk factors and clinical diseases as outcomes. In addition, we considered the clinical and public health impacts of the MedDiet on both human and planetary health. Earlier research confirmed by recent studies has provided strong evidence for the benefits of the MedDiet on cardiovascular health, including reduction in the incidence of cardiovascular outcomes as well as risk factors including obesity, hypertension, metabolic syndrome, and dyslipidaemia. There is also evidence that MedDiet is associated with lower rates of incident diabetes, and better glycaemic control in diabetic patients compared to control diets. In prospective studies, adherence to the MedDiet reduced mortality, especially cardiovascular mortality, hence increased longevity. In addition, it has been associated with less age-related cognitive dysfunction and lower incidence of neurodegenerative disorders, particularly Alzheimer's disease. Furthermore, the relatively low environmental impacts (water, nitrogen and carbon footprint) of the MedDiet is an additional positive aspect of the Mediterranean dietary model. It is likely that the combination of a healthy diet with social behaviours and the way of life of Mediterranean regions makes the MedDiet a sustainable lifestyle model that could likely be followed in other regions with country-specific and culturally appropriate variations.

Recent Advances in Nutrition and Diabetes.

The prevalence of diabetes is on the increase worldwide, being one of the fastest growing international health emergencies in the 21st century [...].

Protective and therapeutic effects of two novel strains of Lactobacilli on diabetes-associated disorders induced by a high level of fructose.

Diabetes is a metabolic disorder described as insufficient secretion of insulin in the pancreas or the inability of the existing insulin to function properly. It poses a greater risk on human health as it is considered the base of several diseases. Thus, this study was designed to evaluate two novel strains of Lactobacillus in handling pancreas disorders. 50 BALB/c male mice were divided into five groups; (a) feeding on normal diet only as control group, (b) given 21% fructose in drinking water as diabetes group, (c) feeding on Lactobacillus rhamnosus strain Pro2 (MT505335.1) plus 21% fructose as LR group, (d) feeding on Lactobacillus plantarum strain Pro1 (MT505334.1) plus 21% fructose as LP group and (e) mixture of two strains plus 21% fructose as Mix group. The serum content of glucose, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was determined. Pancreases histopathology was examined. Expression of GH, IGF1, and GLP-1 genes was measured in the liver and pancreas by RT-qPCR. Serum content of glucose, ALT, and AST significantly increased in diabetes group, and significantly reduced in (LP) and (Mix) groups compared with control. Pathological changes occurred in the exocrine and endocrine components of the diabetes group pancreas. Besides, islet cells are almost entirely disturbed and acinar cells degenerated. However, in (LP) and (Mix) groups, the pathological changes significantly decreased and became related to the control group. Expression of GH, IGF1, and GLP-1 genes was significantly downregulated in the liver and pancreas of mice given fructose compared with control. Expression of these genes was either significantly upregulated in groups (LP and Mix) or identical to the control group. This study shows that the strain Pro1 (MT505334.1) or a combination of two strains is useful in reducing diabetic risk.

(Poly)phenol-Rich Diets in the Management of Endothelial Dysfunction in Diabetes Mellitus: Biological Properties in Cultured Endothelial Cells.

Processed and ready-to-eat foods become routinely consumed resulting in a sharp rise of sugar intake in people's daily diets. The inclusion of fresh fruits and vegetables rich in (poly)phenols has been encouraged by the World Health Organization (WHO) as part of the daily choices to ameliorate endothelial dysfunction and ease the socio-economic burden of diabetes. Research in Food, Nutrition, and Cell Metabolism areas is revealing that the health benefits of (poly)phenol-rich foods go beyond their antioxidant properties and are in fact key modulators of redox and glycaemia status, and inflammatory response contributing to improved endothelial function and vascular health in diabetes. Other beneficial aspects include appetite modulation, regulation of hydrolytic enzymes involved in sugar and lipid metabolism, and mediation of cell-cell aggregation events. This work overviews the current knowledge on the biological properties of ingested (poly)phenols in cultured endothelial cells with emphasis on the circulating (poly)phenols, providing support to (poly)phenol-rich diets as alternatives to drug-based therapies in the prevention, treatment, and management of diabetes. A critical evaluation on the caveats and challenges involve in current experimental cell-based designs and approaches adopted is also discussed.

Estratégias alimentares efetivas para o tratamento da diabetes mellitus em adultos / Effective dietary strategies for the treatment of diabetes mellitus in adults

Pergunta: Quais são as estratégias alimentares mais efetivas para o tratamento de pessoas com diabetes mellitus tipo 1 e tipo 2? Métodos: As buscas na literatura foram realizadas em cinco bases de dados, com restrição de ano de publicação (a partir do ano 2010). Foram incluídas revisões sistemáticas em inglês, português e espanhol que avaliaram o efeito de dietas no tratamento da diabetes mellitus na população adulta. Nesta revisão rápida, produzida em dez dias, a seleção dos artigos, a extração dos dados de interesse e avaliação da qualidade metodológica (por meio do instrumento AMSTAR 2) foram realizadas de forma individual e independente, ou seja, sem revisão de um segundo pesquisador. Após a leitura completa, foi aplicada uma nova restrição de data de publicação, considerando estudos a partir de 2015, devido ao grande quantitativo e à exaustão de conteúdos identificada nos artigos. Resultados: Foram incluídas 31 revisões sistemáticas, a maioria com qualidade metodológica criticamente baixa, de acordo com critérios do AMSTAR 2. Oito categorias de estratégias alimentares foram identificadas: Dietas com modificações nos carboidratos; dietas ovo-lacto-vegetarianas, vegetarianas ou veganas; dieta mediterrânea; programas de jejum ou de jejum intermitente; dietas com modificações nas proteínas; planos alimentares específicos; dietas com restrição de energia e dietas com modificações nas gorduras. Considerando os desfechos de interesse, foram avaliadas tanto medidas de glicose e hemoglobina glicada, quanto medidas antropométricas que podem influenciar no tratamento da diabetes. No geral, as dietas foram descritas como efetivas para obter resultados positivos nos desfechos relacionados à diabetes. Conclusão e limitações: Apenas uma revisão sistemática foi considerada de alta confiança. Nela, houve maior redução da hemoglobina glicada entre pessoas com DM2 que realizaram dieta com baixo teor de carboidratos se comparadas às pessoas que fizeram dietas de consumo padrão de carboidrato (diferença média de −1,0 mmol/mol; p=0,0132). No entanto, para o desfecho de perda de peso, a dieta com baixo teor de carboidratos teve resultados insignificantes quando comparada com dietas de restrição de gorduras. Já na única revisão sistemática de qualidade moderada, a dieta com baixo teor de carboidratos teve resultados mistos (em alguns estudos primários foram positivos, em outros a diferença não foi estatisticamente significante) para glicemia de jejum (pacientes com DM1) quando comparada à dieta de alto teor de carboidrato e ao consumo padrão. Os demais estudos secundários incluídos nesta revisão foram avaliados, em sua maioria, como de qualidade criticamente baixa ou baixa. Isso significa que o grau de confiança que pode ser atribuído a esses achados é pequeno, portanto, mais estudos são necessários para afirmar com segurança o efeito das dietas nos desfechos relacionados à diabetes mellitus. Esta revisão rápida possui limitações que precisam ser consideradas na interpretação dos achados, como as restrições relativas à metodologia de sínteses rápidas, com filtros, processos de seleção, extração e critérios de elegibilidade reduzidos. Em relação às limitações dos estudos primários que compõem as revisões sistemáticas incluídas, os autores relataram a existência de grande heterogeneidade entre os estudos primários, baixa qualidade metodológica, pequeno número de participantes, baixa adesão de participantes ou reporte inadequado da adesão, períodos curtos de seguimento dos resultados, entre outras. Por fim, os resultados aqui apresentados fornecem elementos importantes a serem considerados na construção de estratégias alimentares para o tratamento da diabetes. Além das intervenções aqui relatadas, é importante ressaltar a necessidade de adaptação das estratégias nutricionais para as diferentes populações e contextos, bem como o levantamento de possíveis barreiras e facilitadores que podem impactar a adesão a diferentes dietas.