Institute of Medicine, Food and Nutrition Board: Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC, National Academies Press, 2002
Johnson RI, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J: Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 120:1011–1020, 2011
Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc 108:91–100, 2008
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Sato M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H: Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis. Diabetes Care 32:959–965, 2009
Lovejoy JC. The influence of dietary fat on insulin resistance. Curr Diab Rep 2:435–440, 2002
McClenaghan NH: Determining the relationship between dietary carbohydrate and insulin resistance. Nutr Res Rev 18:222–240, 2005
Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ, Bucher HC: Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors. Arch Intern Med 166:285–293, 2006
Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Iraklianou S, Berdanier CD, Zampelas A: A high protein low fat meal does not influence glucose and insulin responses in obese individuals with or without type 2 diabetes. J Hum Nutr Diet 23:183–189, 2010a
Papakonstantinou E, Triantafilidou D, Panagioitakos DB, Koutsovasilis A, Saliaris M, Manolis A, Melidonis A, Zampelas A: A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes. Eur J Clin Nutr 64:595–602, 2010b
Pearce KL, Clifton PM, Noakes M: Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Br J Nutr 105:584–592, 2011
Peters AL, Davidson MB: Protein and fat effects on glucose responses and insulin requirements in subjects with insulin-dependent diabetes mellitus. Am J Clin Nutr 58:555–560, 1993
Powers MA, Cuddihy RM, Wesley D, Morgan B: Continuous glucose monitoring reveals different glycemic responses of moderate- vs high-carbohydrate lunch meals in people with type 2 diabetes. J Am Diet Assoc 110:1912–1915, 2010
Rosenfalck AM, Almdal T, Biggers L, Madsbad S, Histed J: A low-fat diet improves peripheral insulin sensitivity in patients with type 1 diabetes. Diabet Med 23:384–392, 2006
Savage DB, Petersen KF, Shulman GI: Disordered lipid metabolism and the pathogenesis of insulin resistance. Physiol Rev 87:507–520, 2007
Stirban A, Nandrean S, Götting C, Tamler R, Pop A, Negrean M, Gawlowski T, Stratmann B, Tschoepe D: Effects of n-3 fatty acids on macro- and microvascular function in subjects with type 2 diabetes mellitus. Am J Clin Nutr 91:808–813, 2010
Strychar IS, Cohn JS, Renier G, Rivard M, Aris-Jilwan N, Beauregard H, Meltzer S, Belanger A, Dumas R, Ishac A, Radwan F, Yale J-F: Effects of a diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride concentrations and other cardiovascular risk factors in type 1 diabetes. Diabetes Care 32:1597–1599, 2009
Thomsen C, Storm H, Holst JJ, Hermansen K: Differential effects of saturated and monounsaturated fats on postprandial lipemia and glucagon-like peptide 1 responses in patients with type 2 diabetes. Am J Clin Nutr 77:605–611, 2003
U.S. Department of Agriculture and U.S. Department of Health and Human Services: Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC, U.S. Government Printing Office, 2010 (www.dietaryguidelines.gov)
Vitolins MZ, Anderson AM, Delahanty L, Raynor H, Miller GD, Mobley C, Reeves R, Yamamoto M, Champagne C, Wing RR, Mayer-Davis W, the Look AHEAD Research Group: Action for Health in Diabetes (Look AHEAD) Trial: baseline evaluation of selected nutrients and food group intake. J Am Diet Assoc 109:1367–1375, 2009
Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS: Macronutrients, food groups and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care 35:434–445, 2012
Wolever TSM, Gibbs AL, Mehlin C, Chiasson J-L, Connelly PW, Jesse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA: The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr 87:114–125, 2008
Xu J, Eilat-Adar S, Loria CM, Howard BV, Fabsitz RR, Begum M, Zephier EM, Lee ET: Macronutrient intake and glycemic control in population-based sample of American Indians with diabetes: The Strong Heart Study. Am J Clin Nutr 86:480–487, 2007
Marion J. Franz, MS, RD, CDE, is a Nutrition/Health Consultant at Nutrition Concepts by Franz, Inc., Minneapolis, MN.
Chapter 3 Micronutrients and Diabetes
Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Requirements for Micronutrients: Dietary Reference Intakes
Requirements for Micronutrients in Diabetes
Micronutrient Effects on Glucose and Insulin Homeostasis
Definition and Regulation of Supplements
Highlights Micronutrients and Diabetes
• Dietary reference intakes (DRIs) are reference values that are quantitative estimates of nutrient intakes to be used for planning and assessing diets for healthy people. DRIs consist of four reference intakes: Recommended Dietary Allowance (RDA), Estimated Average Requirement (EAR), Adequate Intake (AI), and Tolerable Upper Intake Level (UL).
• Many micronutrients are involved in carbohydrate and/or glucose metabolism as well as with insulin release and sensitivity. This information, however, is frequently extrapolated beyond what is supported by research findings, and clinical data for most micronutrients for the treatment of diabetes are inconclusive.
• Supplements are defined as any product that is intended to supplement the diet. Dietary supplements contain one or more of the following: vitamin, mineral, herb or other botanical, or amino acid. Unlike drugs, supplements do not need to undergo efficacy or safety testing before being marketed.
• Currently, there is insufficient evidence to support the routine use of supplements for the treatment of diabetes. There are, however, select groups of individuals who may benefit, such as people with poor glycemic control and/or people with a documented deficiency of a given micronutrient or vitamin. Compelling data from well-designed, long-term studies are needed before supplement products can be recommended for widespread