The "Diet Guide" for Asian diabetics is ready for you!

*It is only for medical professionals to read for reference.
Hearing and speaking, can I control sugar effectively if I master the order of eating? Diabetes is currently one of the most serious health problems in the world.
According to statistics, 40% of the world’s diabetic patients are concentrated in Asia, and the number is as high as 250 million
.

The World Diabetes Congress (IDF) once proposed that there are "five carriages" in the comprehensive treatment and management of diabetes, and the medical nutrition treatment we are going to talk about today is one of them
.

For Asian people who are more susceptible to type 2 diabetes (T2DM), it is necessary to pay more attention to diet and make appropriate adjustments based on local characteristics
.

On September 29th, at the 2021 European Association for the Study of Diabetes (EASD) Annual Meeting, Professor Daisuke Yabe from the Faculty of Medicine, Gifu University, Japan gave a report on the medical nutrition treatment of diabetes patients in Asia
.

 Eat vegetables before eating meat.
The rice should be left for the end.
Incretin is an extract of the upper intestinal mucosa that stimulates insulin secretion when blood sugar is elevated.
It includes intestinal inhibitory peptide (GIP).
And glucagon-like peptide-1 (GLP-1)
.

Some researchers compared the incretin levels in the oral glucose tolerance test (OGTT) between whites and Asians, and found that the GIP levels of the two were similar, but Asians had lower GLP-1 levels, regardless of whether they had T2DM or not.

.

Figure 1 OGTT intestinal insulin levels in Caucasians and Asians Since the phenotype of GLP-1 in Asians is lower than that of other races, this phenotype cannot be easily changed, how about trying to "rescue" GLP-1? There really is a way! Researchers have found that eating meat, fish and other meat dishes first during meals, and then staple foods, can stimulate the release of more GLP-1, so that the body can secrete insulin in time to maintain postprandial blood sugar stability (Figure 2).
Meat is eaten first.
The effect is more obvious
.

Figure 2 Eating meat and fish first can stimulate more GLP-1 release.
To analyze the essence of the above phenomenon, we must first understand the main nutrients of each food
.

The main ingredients of staple foods such as rice and noodles are carbohydrates, which can quickly increase blood sugar
.

The main component of meat dishes such as fish and meat is protein, which causes blood sugar to rise not as fast as carbohydrates.
It also stimulates the release of GLP-1 and promotes the body to secrete insulin, so that the blood sugar rises when the staple food is subsequently eaten.
And the amplitude will be significantly reduced
.

But be careful not to have too much fat in meat dishes
.

 In addition, there is an important role in the daily diet-vegetables
.

Although vegetables cannot stimulate the release of incretin, its main component, dietary fiber, can reduce the absorption of glucose, thereby reducing the speed and amplitude of blood sugar rise
.

Relevant clinical trials have proved that the order of eating vegetables first, meat dishes, and staple food at the end can maximize the stability of postprandial blood sugar (Figure 3)
.

 Figure 3 Eat vegetables first, then meat dishes, and eat staple food at the end to maximize the stability of blood sugar after the meal.
If you can’t accept the practice of eating rice when you run out of vegetables at the end, then you can eat one bite of vegetables, one bite of meat, and one bite of rice.
Of
.

Just don't eat a few big mouthfuls of rice and eat only a few vegetables and meat
.

Everyone has "eat well", so how do elderly patients with T2DM "eat well"? Although I have already told T2DM patients how to eat is better for blood sugar, I want to emphasize again how elderly T2DM patients should eat
.

Because even in the principle of dietary arrangements, elderly T2DM patients still focus on reducing blood sugar, blood pressure, lipids and maintaining normal weight, but there are still differences in some specific details
.

 Weight management A multivariate adjusted hazard ratio (HR) study of mortality in T2DM patients in Japan showed that when young patients (<75 years old) and elderly patients (≥75 years old) were stratified into subgroups according to the BMI index, The subgroup with the lowest HR among young patients was BMI 18.
5-22.
4 (HR 0.
90), while the subgroup with the lowest HR among older patients was BMI ≥25.
0 (HR 0.
90) (Figure 4)
.

This shows that if the elderly have sufficient nutritional supply, the risk of death from diabetes can also be reduced.
Therefore, it does not matter if T2DM patients get a little fat in old age
.

Figure 4 Results of multivariate adjusted HR study on mortality of T2DM patients in Japan.
Dietary intake studies have found that protein intake is essential to prevent the elderly with physical weakness and maintain the skeletal muscle weight of elderly diabetic patients (Figure 5)
.

It can be seen that protein plays a pivotal role in the nutritional treatment of the elderly
.

 Figure 5 (Left) The effect of protein intake on the prevention of physical weakness in the elderly; (Right) The effect of protein intake on maintaining the skeletal muscle weight of elderly diabetic patients.
"China Diabetes Diagnosis and Treatment in the Elderly" on January 27, 2021 The guidelines (2021 edition) recommend: 1.
Elderly patients with T2DM should moderately increase their intake of high-quality protein rich in leucine and other branched chain amino acids, and healthy elderly people need to consume 1.
0~1.
3g·kg-1 of protein.
·D-1; Elderly people with sarcopenia or severe malnutrition should take at least 1.
5g·kg-1·d-1 of protein
.

 2.
For carbohydrates, elderly T2DM patients can eat foods rich in dietary fiber while eating this type of food to better delay the increase in blood sugar, reduce blood sugar fluctuations, and improve blood lipid levels
.

However, it is worth noting that elderly patients with gastroparesis and gastrointestinal disorders should avoid excessive intake of dietary fiber
.

 3.
For elderly diabetic patients with unbalanced food intake for a long time, it is also necessary to pay attention to supplementing vitamins and minerals
.

Therefore, for elderly diabetic patients, in addition to drug treatment, medical nutrition therapy is one of the "five carriages" that should also be paid attention to
.

Elderly patients with T2DM would rather be a little bit fat than skinny
.

Eat more fish, beans, fresh vegetables, and whole grains.
Avoid high-fat foods such as fatty meat and meat oil.
It is best to eat in the order of vegetables, fish, and rice
.

This can effectively maintain the stability of blood glucose after meals and reduce the risk of diabetes death
.

References: [1]Kuwata H, Yabe D, Seino Y et al, Diabetologia 2016[2]Kobayashi, et al.
Nutr J, 2013[3]Kubota S, Kuwata H, Yabe D, Seino Y et al.
, JCNM 2019[4]Morino K et al.
, BMJ Open Diabetes Res Care, 2019[5] "Guidelines for Diagnosis and Treatment of Diabetes in the Elderly in China (2021 Edition)"