SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 10 NUMBER 3 • SEPTEMBER 2013
83
The diet – central in the treatment of diabetes and
polycystic ovarian syndrome
T
he diet is a topic discussed and written about extensively.
It plays a pivotal role in the management of diabetes, both
type 1 and type 2, as well as in polycystic ovarian syndrome
(PCOS). PCOS can be seen as a major risk factor and probably a
marker of future risk for the development of diabetes.
Unfortunately, patients often don’t cope well with our dietary
recommendations, which probably contributes more to poor
control than any other aspect of diabetes. It is also well recognised
that a drastic improvement in diet can improve diabetes control in
type 2 diabetes (as measured by plasma HbA
1c
level) more than any
medication, only rivaled by insulin.
Patients are however particularly lax in complying with their
diets, especially over time, contributing to progressive worsening of
glycaemic control. Many diabetics have been admitted to metabolic
units with very poor HbA
1c
levels, and yet they had perfect control
documented in hospital on unchanged regimes. The problem – the
diet at home!
Unfortunately, studying diet in official studies is very difficult. It
is surprising how weak the evidence is on which we base the most
important component of our treatment.
In recent years there has been a movement towards higher
protein diets, which in the short term led to better weight
control and compliance. This was often driven by people outside
the diabetes field and in South Africa; the example of Prof Tim
Noakes jumps to mind. In PCOS the diet should probably be
similar to that of a diabetic, except that weight loss is even
more important and it has been well documented to reverse this
syndrome.
It makes sense for diabetics to restrict their carbohydrate intake
as this can contribute to improvement in glycaemic control. Recently
published studies confirm this, showing that diabetes can be cured
through a strict diet (very low calorie diet) in a significant percentage
of patients. It was unfortunate that the Look AHEAD study could
not show cardiovascular benefit with lifestyle intervention.
In this issue, Krebs and colleagues discuss different diets and the
available data in diabetes. They try to answer the question: What is
the optimal diet for a diabetic?
Tomlinsen and co-workers present an informative article on
the cardiometabolic risk of PCOS and how screening for this risk
should be assessed. This common condition is under-diagnosed
and therefore practitioners also miss the associated cardiovascular
risk.
Viljoen
et al
. discuss the safety and efficacy of DPP-4 inhibitor
use in the elderly. The DPP-4 inhibitors are currently topical and
underused in South Africa, largely due to funder restrictions.
References
1. Iris Shai RD. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.
New Engl J Med
2008;
359
(3): 229–341.
2. The Look AHEAD research group. Cardiovascular effects of intensive lifestyle
intervention in type 2 diabetes.
N Engl J Med
2013;
369
: 145–154.
3. Lim EL, Hollingsworth KG, Taylor R. Reversal of type 2 diabetes: normalisation of
beta cell function in association with decreased pancreas and liver triacylglycerol.
Diabetologia
2011;
54
(10): 2506–2514.
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2013;
10
: 83
LANDI LOMBARD
