Ernährungsmedizin bei Typ-2-Diabetes – die aktuelle Studienlage – Weit mehr als eine Versorgung des Körpers mit Nährstoffen

Die nutritive Therapie bei Menschen mit Typ-2-Diabetes reicht weit über die Versorgung des Körpers mit Nährstoffen hinaus. Vor dem Hintergrund einer komplexen Dysregulation des Glukosemetabolismus ist sie – neben der medikamentösen Therapie – eine wertvolle Strategie, um einer Stoffwechselentgleisung vorzubeugen. Vor allem die Zufuhr von Ballaststoffen scheint nach wie vor einer der wichtigsten Ansatzpunkte zu sein, um den Blutglukoseverlauf zu glätten und die Magenentleerung zu verzögern. Zudem stellt sich die Frage, ob die bisherigen verhaltenen Empfehlungen zum Verzehr von Obst für Patienten mit Typ-2-Diabetes (noch) gerechtfertigt erscheinen oder ob sich hier nicht bisher wenig genutzte Chancen für eine erhöhte Aufnahme von Ballaststoffen, Vitaminen und sekundären Pflanzeninhaltsstoffen ergeben. Auch Mikronährstoffdefizite sind bei Patienten mit Typ-2-Diabetes beschrieben. Ein Vergleich aktueller Studien zur Supplementierung mit Chrom zeigt jedoch, wie differenziert die Frage nach einer Supplementierung betrachtet werden muss.

The „medical nutrition therapy“ in patients with type 2 diabetes mellitus is much more than providing energy and all essential nutrients. Considering the complex dysregulation of the glucose metabolism in patients with type 2 diabetes mellitus it rather is a valuable strategy to avoid uncontrolled blood glucose – besides the pharmacological treatment. Above all fiber intake may still be one of the most important approaches to smooth blood glucose curves and to delay gastric emptying. Additionally it is arguable, whether current recommendations on restricted fruit intake for patients with type 2 diabetes mellitus are still justified and whether this area may present a underutilised source for an increased intake of fibers, vitamins and phytochemicals. Micronutrient deficiencies are common in people with diabetes type 2 mellitus as well, which often is associated with the discussion about the benefits and risks of supplementation. Current studies related to the supplementation of chromium show how differentially the evaluation needs to be done in that case.

Key words

medical nutrition therapy - fibers - fruit intake - chromium supplementation

• Literatur

• 1 Paris AS, Carceller DB, Lacleta IM, Gamboa RA. Sugar and diabetes; international recommendations. Nutr Hosp 2013; 28 (Suppl. 04) 72-80
• 2 American Diabetes Association. Bantle JP, Wylie-Roselt J et al. Nutritions recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008; 31
• 3 Franz MJ, Powers MA, Leontos C et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc 2010; 110: 1852-1889
• 4 Mann JI, De Leeuw A, Hermansen K et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 2004; 14: 373-394
• 5 Diabetes UK 2011. British Diabetic Association. Evidence-based nutrition guidelines for the prevention and management of diabetes. http://www.diabetes.org.uk
• 6 Rodbard HW, Blonde I, Braithwaite SS et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract 2007; 13 (Suppl. 01) 47-49
• 7 Jonnalagadda SS, Harnack L, Liu RH et al. Putting the whole grain puzzle together: health benefits associated with whole grains – summary of American Society for Nutrition 2010 Satellite Symposium. J Nutr 2011; 141
• 8 Yu K, Ke MY, Li WH et al. The impact of soluble dietary fibre on gastric emptying, postprandial blood glucose and insulin in patients with type 2 diabetes. Asia Pac J Clin Nutr 2014; 23: 210-218
• 9 Silva FM, Kramer CK, de Almeida JC et al. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr Rev 2013; 71: 790-801
• 10 Hlebowicz J, Jonsson JM, Lindstedt S et al. Effect of commercial rye whole-meal bread on postprandial blood glucose and gastric emptying in healthy subjects. Nutr J 2009; 8: 26-30
• 11 Bajorek SA, Morello CM. Effects of dietary fiber and low glycemic index diet on glucose control in subjects with type 2 diabetes mellitus. Ann Pharmacother 2010; 44: 1786-1792
• 12 Overby NC, Margeirsdottir HD, Brunborg C et al. The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment. Diabetologia 2007; 50: 2044-2051
• 13 Gulliford MC, Ukoumunne OC. Determinants of glycated haemoglobin in the general population: associations with diet, alcohol and cigarette smoking. Eur J Clin Nutr 2001; 55: 615-623
• 14 Buyken AE, Toeller M, Heitkamp G et al. Carbohydrate sources and glycaemic control in Type 1 diabetes mellitus. EURODIAB IDDM Complications Study Group. Diabet Med 2000; 17: 351-359
• 15 Panagiotakos DB, Tzima N, Pitsavos C et al. The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study. Rev Diabet Stud 2005; 2: 208-215
• 16 Christensen AS, Viggers L, Hasselström K, Gregersen S. Effect of fruit restriction on glycemic control in patients with type 2 diabetes – a randomized trial. Nutr J 2013; 12: 29-29
• 17 Al-Maskari MY, Waly MI, Ali A et al. Folate and vitamin B₁₂ deficiency and hyperhomocysteinemia promote oxidative stress in adult type 2 diabetes. Nutrition 2012; 28
• 18 Gariballa S, Afandi B, Haltem MA et al. Effect of antioxidants and B-group vitamins on risk of infections in patients with type 2 diabetes mellitus. Nutrients 2013; 5: 711-724
• 19 Cefalu WT, Hu FB. Role of chromium in human health and in diabetes. Diab Care 2004; 27: 2741-2751
• 20 Racek J, Sindberg CD, Moesgaard S et al. Effect of chromium-enriched yeast on fasting plasma glucose, glycated haemoglobin and serum lipid levels in patients with type 2 diabetes mellitus treated with insulin. Biol Trace Elem Res 2013; 155: 1-4
• 21 Kleefstra N, Bilo HJG, Bakker SJL, Houweling ST. Chroom en insulineresistentie. Ned Tijdschr Geneesk 2004; 148: 217-220
• 22 Guimarães MM, Martins Silva Arvalho AC, Silva MS. Chromium nicotinate has no effect on insulin sensitivity, glycemic control, and lipid profile in subjects with type 2 diabetes. J Am Coll Nutr 2013; 32: 243-250
• 23 Gunton JE, Cheung NW, Hitchman R et al. Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile. Diab Care 2005; 28: 712-713