"Guidelines for Nutrition Treatment of Diabetes Medicine in China (2022 Edition)" released! A total of 86 recommendations were involved

Medical nutrition therapy (MNT) is the basis of comprehensive treatment of diabetes and is an essential measure
for prevention and control at any stage of the diabetes course.
Recently, the "Guidelines for Nutrition Treatment of Diabetes Medicine (2022 Edition)" jointly written by experts in relevant fields from the Clinical Nutrition Branch of the Chinese Nutrition Society, the Diabetes Branch of the Chinese Medical Association, the Parenteral Enteral Nutrition Branch and the Dietitian Professional Committee of the Chinese Medical Doctor Association, was released
in the Chinese Journal of Diabetes.

The guide provides clinical guidance on 86 questions on diabetes nutrition therapy in the form of "question and answer pairs", and this article organizes the core content and shares
it with teachers.

Medical nutrition treatment process for diabetes

The medical nutrition treatment process for diabetes is shown in Figure 1
.

Figure 1 Medical nutrition treatment process of diabetes

Question 1: What is the appropriate energy range for diabetics?

Guidelines recommend that people with diabetes should receive an individualized energy balance plan to achieve or maintain an ideal weight and meet the goals of nutritional needs in different situations (B, highly recommended)

Table 1 Daily energy supply of adult diabetic patients [kJ/kg(kcal/kg)]

Question 2: Does a low-calorie/very low-calorie diet help blood glucose management in people with T2DM?

The guidelines recommend:

1.
Short-term (<1 year) low-calorie diet (LCD) helps weight and blood glucose management in overweight/obese diabetic patients (A, highly recommended)

2.
Very low-calorie diet (VLCD) can help improve FBG, HbA1c, insulin resistance, weight and other indicators (C, weak recommendation) in patients with T2DM in the short term, but complications such as hypoglycemia may occur, and long-term VLCD (C, strong recommendation) is not recommended

Question 3: What is the effect of intermittent sexual energy restriction/continuous sexual energy restriction on glycolipid metabolism and body weight in patients with T2DM?

Guidelines suggest that intermittent sexual energy restriction/sustained sexual energy restriction (IER/CER) are beneficial to blood glucose and weight management in overweight/obese T2DM patients, and IER has more advantages over CER in weight management (B, weak recommendation)

Question 4: What is the effect of carbohydrate intake on blood sugar control, insulin levels, and risk factors for complications?

The guidelines suggest that the daily carbohydrate energy supply ratio of diabetic patients should be 45%~60% (B, strongly recommended).

Carbohydrate-restricted diets are beneficial for glycaemic control in patients with T2DM in the short term (within 1 year), may slightly improve TG and HDL-C levels, and no long-term benefit has been found (B, weak recommendation).

Very low carbohydrate diets are not recommended for people with type 1 diabetes (C, strongly recommended)

Question 5: Does carbohydrates from different food sources have an effect on blood sugar control, insulin levels and complications and their risk factors?

Guidelines recommend: Whole grain carbohydrate replacement of some refined grains is beneficial for blood sugar, triglyceride (TG), and weight control (B, strongly recommended)

Q6: What is the effect of the content and source of dietary fiber (not supplements or supplements) on blood sugar control and complications?

Guidelines suggest: a diet high in dietary fiber (25~36 g/d or 12~14 g/1 000 kcal), especially to ensure soluble dietary fiber intake (10~20 g/d), helps to control blood glucose in patients with T1DM and T2DM and reduce all-cause mortality (B, strongly recommended)

Question 7: What are the effects of specific carbohydrates (sucrose, fructose) on blood sugar control, insulin levels, etc.
?

Guidelines recommend that routine addition of sucrose
is not recommended for patients.
Isoenergy replacement/increase of some carbohydrates in the diet for sucrose (30~50g) does not affect blood sugar control or insulin sensitivity (C, weak recommendation).

Isoenergetic replacement carbohydrates for high doses of added fructose >50 g, with increased risk of TG (C, weak recommendation)

Question 8: What is the recommended daily intake of total dietary fat and various fatty acids for patients with T2DM?

Guidelines suggest: It is recommended that the total daily dietary fat energy supply accounts for 20%~35%
of the total energy.
Emphasize that the quality of fat is more important than the proportion, limit the intake of saturated fatty acids and trans fatty acids, recommend that the intake of saturated fatty acids does not exceed 12% of total energy, trans fatty acids do not exceed 2%, and appropriately increase polyunsaturated and monounsaturated fatty acids to replace partially saturated fatty acids (B, strongly recommended)

Q9: Do diabetics need to limit cholesterol intake?

Guidelines recommend that cholesterol intake in patients with T2DM should not exceed 300 mg/day (B, weak recommendation)

Q10: Is omega-3 polyunsaturated fatty acid supplementation beneficial for T2DM?

Guidelines recommend: omega-3 polyunsaturated fatty acid supplementation helps reduce TG levels in patients with T2DM, but the effect on glycaemic control is unclear (B, strongly recommended)

Question 11: What is the proportion of protein intake of diabetic patients with normal kidney function to total energy intake? Does increasing protein intake help control blood lipids and blood sugar?

The guidelines suggest that protein intake in diabetic patients with normal renal function should account for 15%~20% of total energy (B, strongly recommended).

Short-term, high-protein diets help improve weight, lipids, and blood sugar in overweight and obese diabetics (B, weak recommendation)

Q12: What are the effects of whey protein and soy protein on blood sugar and weight in diabetics?

Guidelines recommend: Whey protein helps promote insulin secretion, improves glucose metabolism, maintains muscle mass, and is more helpful in weight control in the short term (D, weak recommended), and plant-derived protein, especially soy protein, is more helpful in lowering blood lipid levels than animal protein (D, weak recommended)

Q13: What are the effects of vitamin E supplementation on diabetics?

Guidelines suggest: Vitamin E supplementation may be beneficial in diabetics with the Hp2-2 genotype, but safety and long-term efficacy remain to be studied (D, weak recommendation)

Q14: What are the effects of folic acid supplementation on people with diabetes?

Guidelines suggest: folic acid supplementation may be beneficial for blood glucose homeostasis and reduce insulin resistance (C, weak recommendation)

Q15: What are the effects of vitamin D supplementation in pre-diabetic people and diabetics?

Guidelines suggest: there is no evidence that vitamin D supplementation in diabetic and pre-diabetic populations has the effect of delaying the onset of diabetes or lowering blood glucose (C, weak recommendation).

In certain cases, high-dose vitamin D supplementation may slightly lower blood sugar, but routine vitamin D supplementation for the purpose of lowering glucose is not recommended (B, strongly recommended)

Q16: What are the effects of multivitamin and mineral supplementation in people with T2DM?

Guidelines suggest that multivitamin and mineral supplementation may be beneficial to blood glucose and lipid metabolism in patients with T2DM and obesity, and its effectiveness needs further research (C, weak recommendation)

Question 17: Is chromium supplementation beneficial for diabetes?

Guidelines suggest that chromium deficiency may be associated with the development of diabetes, but there is no consistent evidence that routine chromium supplementation is beneficial for glycemic and lipid control in diabetic patients (C, weak recommendation)

Question 18: What are the effects of nutritional sweeteners on blood sugar control, insulin, etc.
?

Guidelines suggest that short-term intake of low-dose fructose sweeteners or allulose in adults with T2DM does not increase postprandial blood glucose (D, weak recommendation).

In patients with T2DM who met the goal of glycemic control, xylitol instead of glucose had no significant effect on blood glucose 2 h after prandial (C, weak recommendation)

Q19: What are the effects of non-nutritive sweeteners on blood sugar, insulin and weight control?

Guidelines suggest: non-nutritive sweeteners such as steviol glycosides, sucralose, aspartame, and saccharin had no significant effect on FBG, HbA1c, and BMI in patients with T2DM (B, weak recommendation)

Q20: What is the effect of alcohol and alcoholic beverages on blood sugar control?

Guidelines suggest: alcohol is not beneficial for glycaemic control in patients with T2DM, but alcohol consumption increases the risk of hypoglycemia in patients with T1DM and is not recommended for diabetics (B, strongly recommended)

Question 21: What is the effect of phytochemical polyphenols on blood sugar regulation in patients with T2DM?

Guidelines suggest: phytochemicals polyphenols may be beneficial for the prevention and treatment of diabetes and complications (D, weak recommendation), proanthocyanidins may be beneficial for blood glucose control (B, weak recommendation)

Q22: What is the effect of soy isoflavones on inflammation and complications in diabetics?

Guidelines suggest that soy isoflavones may be beneficial to blood glucose and lipids in men with T2DM, and soy intake is inversely correlated with the risk of T2DM (D, weak recommendation)

Question 23: Can the Mediterranean diet prevent the occurrence of T2DM, improve blood sugar and lipid control, and reduce the risk of cardiovascular disease?

Guidelines suggest: Mediterranean diet helps reduce the risk of T2DM, helps control blood glucose in patients with T2DM, and helps increase HDL-C, reduce LDL-C and TG levels, and thus reduce the risk of cardiovascular disease (A, strongly recommended)

Question 24: Does a dietary therapy diet for discontinuing hypertension prevent the development of T2DM? Can T2DM improve blood sugar and lipids and reduce the risk of cardiovascular disease?

Guidelines recommend that a discontinuation of a hypertensive dietary therapy (DASH) diet reduces the risk of T2DM and fasting insulin levels in patients with T2DM, but does not significantly improve the insulin resistance index (HOMA-IR) assessed by FBG and homeostatic models (B, weak recommendation)

Question 25: What are the effects of probiotic supplementation on glucose metabolism in patients with T2DM?

Guidelines suggest: supplementation with specific probiotics may improve glycemic control in patients with T2DM (B, weak recommendation)

Question 26: Can prebiotic supplementation help improve glycemic control in patients with T2DM?

Guidelines suggest: Supplementation with specific prebiotics can help improve glycemic control and reduce markers of inflammation in patients with T2DM (C, weak recommendation)

Question 27: Does synbiotic supplementation benefit blood sugar improvement in T2DM patients?

Guidelines recommend that patients with T2DM can supplement with specific synbiotics to improve blood glucose, and that supplementation with synbiotics may result in better metabolic improvements than probiotics (C, weak recommendation)

Q28: What are the effects of probiotic/prebiotic/synbiotic supplementation on glycemic control in patients with T1DM?

Guidelines suggest: the effect of probiotic use in patients with T1DM on glycaemic control is unclear, but specific synbiotics or prebiotics may improve glycaemic control in children (D, weak recommendation)

Question 29: Does diabetes education have an impact on the risk of developing diabetes?

Guidelines recommend that diabetes education-guided lifestyle interventions help improve glucose tolerance, reduce or delay the onset of diabetes, and help reduce the occurrence of chronic complications of diabetes (A, strongly recommended).

Q30: Does diabetes nutrition education and exercise guidance have an impact on weight and glycemic control in people with diabetes?

Guidelines suggest: The comprehensive management of diabetes nutrition education, diet and exercise can reduce weight, waist circumference, HbA1c and blood sugar levels, increase nutritional knowledge and improve diet quality, and benefit from blood lipids and blood pressure (B, strongly recommended)

Question 31: Does a low glycemic index/glycemic load diet help people with diabetes control their blood sugar?

Guidelines recommend that a diet high in GI/GL significantly increases the risk
of T2DM in healthy people.
Low GI/GL diets are more effective than high GI/GL diets in controlling FBG, PBG, and HbA1c without increasing the incidence of hypoglycaemic events (A, highly recommended)

Question 32: Does a low glycemic index/glycemic load diet help control complications in people with diabetes?

Guidelines suggest: A low GI diet may be beneficial for diabetes complication control (C, weak recommendation)

Question 33: Does the food exchange method help people with diabetes control their blood sugar levels?

Guidelines suggest: The food exchange method is simple to operate and helps people with diabetes control total energy and blood glucose levels (C, strongly recommended)

Question 34: Compared with the traditional food exchange method, is the food exchange method based on low glycemic load beneficial to blood sugar control?

Guidelines suggest: Medical nutrition therapy (MNT) combined with low-GL food exchange is more conducive to glycemic control and helps improve weight, BMI and lipid metabolism compared with traditional food exchange (B, weak recommendation)

Question 35: Can carbohydrate counting help with glycemic control in patients with T1DM?

Guidelines recommend: Carbohydrate counting-based nutritional interventions may help improve glycaemic control and quality of life in children and adults with T1DM (C, strongly recommended)

Question 36: Is carbohydrate counting helpful for glycemic control in patients with T2DM?

Guidelines suggest that carbohydrate counting is effective in lowering blood glucose levels in patients with T2DM (B, weak recommendation)

Question 37: What are the effects of different dietary patterns on blood glucose and metabolism in children and adolescents with T1DM?

The guidelines recommend that a flexible dietary pattern with low GI and high dietary fiber based on the principle of a balanced diet, with an emphasis on regular meals, is helpful for glycemic management in patients with T1DM (B, strongly recommended).

A high-fat diet (fat-to-energy ratio >35%) is not recommended for children and adolescents with T1DM, and a balanced diet that moderately increases the proportion of monounsaturated fatty acid intake can improve blood lipids and blood glucose (B, strongly recommended)

Question 38: What are the effects of protein intake on metabolism and insulin therapy in children and adolescents with T1DM?

Guidelines recommend: a high-protein, high-fat diet (protein-to-energy ratio ≥25%) is not recommended in children and adolescents with T1DM (B, strongly recommended)

Question 39: What is the effect of vitamin D on children and adolescents with T1DM?

The guidelines suggest that vitamin D treatment should help improve blood glucose and lipid levels and reduce the risk of complications in children and adolescents with T1DM in children with vitamin D deficiency; Routine monitoring of vitamin D levels and prompt supplementation (C, strongly recommended)

Question 40: What is the effect of nutritional weight loss interventions on blood glucose in overweight and obese children and adolescents with T1DM and T2DM?

Guidelines recommend that overweight and obese children and adolescents with T1DM and T2DM need to improve obesity and blood glucose levels through nutritional weight loss interventions (C, strongly recommended)

Question 41: Does folic acid supplementation during pregnancy help reduce the risk of gestational diabetes?

Guidelines recommend that supplementation with an additional 400 micrograms of folic acid daily in addition to a balanced diet before and during the first trimester is beneficial in reducing the risk of GDM, but may also increase the risk of GDM if folic acid supplementation exceeds 800 micrograms (B, weak recommendation)

Question 42: Does intake of plant protein during pregnancy help reduce the risk of gestational diabetes?

Guidelines suggest that the diet during pregnancy should balance protein intake and types, and increasing plant proteins such as legumes and nuts is conducive to reducing the risk of GDM (B, strongly recommended)

Question 43: What is the effect of a low glycemic index diet on glycemic control in gestational diabetes?

Guidelines suggest: A low GI diet helps glycemic control in GDM (C, weak recommendation)

Q44: Do diabetes-specific nutritional preparations improve clinical outcomes in gestational diabetes?

Guidelines recommend that diabetes-specific nutritional preparations help improve blood glucose levels and perinatal outcomes in people with GDM, and reduce the risk of hypoglycaemia and inadequate energy intake (C, weak recommendation)

Question 45: Do gestational diabetics need dietary fiber supplementation?

Guidelines recommend that dietary fiber supplementation during pregnancy in patients with GDM can help regulate blood glucose levels and improve clinical outcomes (B, strongly recommended)

Q46: Do people with gestational diabetes need micronutrient supplementation?

Guidelines recommend that patients with GDM should maintain good micronutrient intake and, if necessary, supplementation with pregnancy-appropriate micronutrient complexes (C, weak recommendation)

Question 47: How much energy should elderly diabetics consume?

Guidelines suggest: the recommended energy intake of elderly diabetic patients is 25~30 kcal/kg per day, and for elderly patients with malnutrition or nutritional risk, energy intake needs to be increased (B, strongly recommended)

Q48: What are the effects of increasing protein intake on older diabetics?

Guidelines suggest that adequate protein intake can improve the frail state of elderly diabetic patients and prevent the occurrence of sarcopenia (B, strongly recommended)

Q49: Do elderly diabetic patients need vitamin and trace element supplementation?

Guidelines suggest that elderly diabetic patients should maintain an appropriate intake of vitamins and trace elements, especially increase adequate intake of vitamin D and calcium (C, strongly recommended)

Question 50: Does lifestyle intervention in prediabetes help delay the onset and complications of T2DM?

Guidelines suggest that lifestyle interventions in prediabetes delay the onset of T2DM and reduce cardiovascular events, microvascular complications, and cardiovascular and all-cause mortality (A, strongly recommended)

Question 51: For overweight/obese pre-diabetic people, does weight loss reduce the occurrence of T2DM?

Guidelines suggest: For overweight and obese pre-diabetic people, it is recommended to lose 7%~10% of weight to reduce the occurrence of T2DM (B, strongly recommended)

Question 52: In people with prediabetes, is precision nutrition therapy beneficial for blood glucose management and prevention of T2DM?

Guidelines suggest: Personalized diet combining individual biological data (such as microbiome, genome, and metabolome), lifestyle factors (such as sleep and exercise) information can help PBG control in patients with T2DM such as prediabetes and obesity and high-risk groups (B, weak recommendation)

Question 53: Do T2DM patients need protein supplementation after metabolic surgery?

Guidelines suggest: It is recommended that patients with T2DM undergo protein supplementation according to the nutritional management guidelines of metabolic surgery, and the postoperative protein intake should meet 60~120 g/d (C, weak recommendation)

Question 54: Do patients with T2DM need iron supplementation after metabolic surgery?

Guidelines recommend that patients with T2DM regularly monitor iron metabolism indicators after metabolic surgery (especially in women and after RYGB surgery), and should be supplemented
in time once iron deficiency occurs.
Supplementation can be supplemented with ferrous sulfate, ferric fumarate or iron gluconate supplemented with vitamin C, and the oral dose is 150~200 mg/d (B, strongly recommended)

Q55: Do T2DM patients need calcium and vitamin D supplementation after metabolic surgery?

Guidelines suggest: It is recommended that patients with T2DM regularly monitor vitamin D levels after surgery, daily prophylactic oral calcium 1 200~1 500 mg and vitamin D preparations 3 000 U (C, strongly recommended)

Question 56: Do patients with T2DM need B vitamin supplementation after metabolic surgery?

Guidelines recommend routine monitoring of vitamin B12 levels after metabolic surgery in patients with T2DM, and oral methylvitamin B12 (1 000 micrograms/day) to levels that are acceptable in patients with vitamin B12 deficiency
.
For patients with symptoms of vitamin B1 deficiency, oral supplementation of vitamin B1 100 mg twice or three times daily until symptoms disappear (C, strongly recommended)

Question 57: Do T2DM patients need vitamin A supplementation after metabolic surgery?

Guidelines suggest: It is recommended to monitor vitamin A levels after metabolic surgery in patients with T2DM, and supplement 5 000~10 000 U/d for vitamin A deficiency patients (C, weak recommendation)

Question 58: How can patients with T2DM prevent hypoglycemia after metabolic surgery?

Guidelines recommend a high-fiber, low-GI diet, or low-carbohydrate, high-protein diet (C, weak recommendation) for patients with T2DM who develop postmetabolic hypoglycaemia

Q59: How can perioperative nutrition management promote metabolic surgery outcomes in patients with T2DM?

Guidelines suggest: perioperative glucose monitoring, medication, and dietary regulation can effectively control glycaemia, reduce surgical risks, and improve surgical prognosis (B, strongly recommended)

Q60: How should long-term nutritional management be carried out after metabolic surgery in patients with T2DM?

Guidelines suggest: T2DM patients should be given long-term nutritional guidance by a professional nutrition team after metabolic surgery, including diet planning, exercise guidance, and help patients develop good eating habits and lifestyle rules (B, strongly recommended), T2DM patients should use high-fiber cereals and fruits as the main carbohydrate source after weight loss surgery, increase fresh vegetable intake, and reduce the intake of high-energy, high-fat foods (C, weak recommendation)

Q61: How should nutrition be managed for patients with poor diabetes remission after metabolic surgery?

Guidelines recommend that MNT in combination with pharmacotherapy can help control glycaemia, and corrective surgery may be considered in patients with refractory hyperglycaemia or recurrent metabolic disease, but evidence-based medical evidence is lacking (C, weak recommendation)

Question 62: What nutritional support should be chosen for comorbid stress hyperglycemia?

Guidelines recommend: enteral nutrition should be preferred with stress hyperglycemia (B, strongly recommended)

Question 63: Can diabetes-specific enteral nutrition preparations be used for stress hyperglycemia?

Guidelines recommend the use of diabetes-specific enteral nutrition in patients with stress hyperglycaemia (B, strongly recommended)

Question 64: What is the range of glycaemic goals when stressful hyperglycemia occurs in critically ill patients?

Guidelines suggest that insulin therapy is recommended when the blood glucose of critically ill patients reaches 10.
0 mmol/L, and the goal is to control blood glucose at 7.
8~10.
0 mmol/L
.
Blood glucose should be monitored regularly to prevent the risk of hypoglycaemia (<3.
9 mmol/L for hypoglycaemic level requiring intervention) (A, strongly recommended)

Question 65: Is the nutritional risk/malnutrition in diabetic hospitalized patients higher than in non-diabetic hospitalized patients?

Guidelines recommend that hospitalized patients with diabetes have a higher incidence of nutritional risk/malnutrition and should undergo routine nutritional screening and assessment (B, strongly recommended)

Q66: Do diabetes-specific enteral nutrition preparations have a better effect on blood sugar than whole-nutrient standard formulations?

Guidelines recommend that diabetes-specific enteral nutrition (EN) formulations have a better effect on insulin requirements, FBG, and HbA1c than standard formulations (B, strongly recommended)

Question 67: Does the implementation of specific enteral nutrition therapy for diabetes improve health economics?

Guidelines suggest: Standardized use of diabetes-specific EN formulations can reduce healthcare resource consumption (B, strongly recommended)

Question 68: How can diabetic kidney disease patients prevent malnutrition?

Guidelines suggest that people with diabetic kidney disease are more likely to develop malnutrition when on a low-protein diet, and suggest that adequate energy intake can prevent malnutrition (C, weak recommendation).

For patients with diabetic kidney disease who are pre-malnourished, the lower the protein intake, the higher the risk of death, and a low-protein diet is not recommended (C, weak recommendation).

Patients with diabetes treated on dialysis often have lower daily energy intake than non-diabetic patients, and restrictive regimens should be used with caution (D, weak recommendation)

Q69: How should diabetic kidney disease patients with malnutrition improve their nutritional status?

The guidelines suggest that patients with diabetic kidney disease with malnutrition should give preference to oral nutritional supplementation, and nephropathy-appropriate nutritional supplements can improve malnutrition while avoiding increased phosphate binding and electrolyte imbalance (C, weak recommendation)

Question 70: How can diabetic kidney disease patients with hyperphosphatemia improve their blood phosphate status?

Guidelines suggest that for patients with diabetic kidney disease with hyperphosphatemia, appropriate phosphorus binders can be selected to control high phosphate levels after dietary modification is ineffective (B, weak recommendation)

Question 71: Does diabetic kidney disease require routine vitamin D supplementation or its analogues?

Guidelines recommend that oral vitamin D3 supplementation be beneficial in improving serum vitamin D status and dyslipidemia for diabetic nephropathy with vitamin D deficiency (C, weak recommendation).

There is no uniform conclusion on whether proteinuria and renal function can improve diabetic nephropathy, and routine use is not recommended (C, weak recommendation)

Question 72: What is the effect of dietary fatty acid sources on lipid metabolism in patients with T2DM?

Guidelines suggest that reducing dietary saturated fat is beneficial in reducing the risk of
cardiovascular disease in patients with T2DM.
Saturated fatty acid intake does not exceed 10% of total energy, trans fatty acids do not exceed 1% of total energy, and routine use of omega-3 dietary supplements to improve lipid disorders in diabetic patients is not supported (C, strongly recommended)

Question 73: What effect of dietary cholesterol on cardiovascular events in diabetics?

Guidelines recommend: reduce cholesterol intake in diabetic patients with lipid dysmetabolism (C, strongly recommended)

Question 74: Does supplementation with the vitamin B12 derivative (methylcobalamin) improve diabetic neuropathy?

Guidelines suggest that a derivative of vitamin B12 (methylcobalamin) may improve spontaneous limb pain, numbness, nerve reflexes, and conduction disorders in diabetes, and that methylcobalamin plus α-lipoic acid is more effective than methylcobalamin alone (C, weak recommendation)

Question 75: Does α-lipoic acid improve diabetic neuropathy?

Guidelines suggest that α-lipoic acid may improve neurosensory symptoms and nerve conduction velocity, improve neuroelectrophysiological changes, mitigate and delay the development of neurological damage, and that oral supplementation is comparable to that of injectable forms (C, weak recommendation)

Question 76: Does vitamin D supplementation improve diabetic neuropathy?

Guidelines suggest that high-dose vitamin D supplementation may be beneficial in improving neuropathy symptoms and quality of life in patients with T2DM (D, weak recommendation)

Question 77: Does supplementation with pharmacological amino acids such as arginine have an effect on the healing of diabetic foot ulcers?

Guidelines suggest: supplementation with pharmacologically acting amino acids such as arginine may promote healing of diabetic foot ulcers (C, weak recommendation)

Question 78: Does vitamin D supplementation have an effect on the healing of diabetic foot ulcers?

Guidelines suggest: High-dose vitamin D supplementation may promote healing of diabetic foot ulcers (C, weak recommendation)

Q79: Does zinc supplementation have an effect on the healing of diabetic foot ulcers?

Guidelines suggest: zinc supplementation may promote ulcer healing in diabetic foot (D, weak recommendation)

Q80: Does magnesium supplementation have an effect on the healing of diabetic foot ulcers?

Guidelines suggest: magnesium supplementation may promote healing of diabetic foot ulcers (D, weak recommendation)

Question 81: Do GLP-1 receptor agonists help patients with obesity/overweight T2DM lose weight?

Guidelines suggest: GLP-1 agonists promote weight loss in patients with obese/overweight T2DM (A, strongly recommended)

Question 82: Do GLP-1 receptor agonists affect the muscular condition of the body?

Guidelines suggest that GLP-1 receptor agonists combined with energy restriction and rigorous lifestyle interventions may lead to muscle and lean body mass loss in people with diabetes, but their effect on muscle alone is inconclusive (B, weak recommendation)

Question 83: Can SGLT2i reduce body weight?

Guidelines suggest that SGLT2i promotes weight loss and body composition changes characterized by body fat loss in diabetics (B, strongly recommended)

Question 84: Does SGLT2i affect the body's bone metabolism?

Guidelines suggest: The effect of SGLT2i on bone metabolism in the body is inconclusive, canagliflozin and dapagliflozin may promote bone density loss, bone loss, and the nutritional status of calcium, phosphorus and vitamin D still needs to be closely observed during medication (C, weak recommendation)

Question 85: Do diabetics using SGLT2i need special dietary management?

Guidelines suggest that SGLT2i can promote glucose excretion through the kidneys, thereby feedbackally reducing insulin production and promoting glucagon secretion, tending to promote gluconeogenesis and ketone body production
.
It is recommended to avoid very low energy intake and maintain a carbohydrate-to-energy ratio of not less than 40% of the daily dietary energy to avoid inducing euglycemic or hyperglycemic diabetic ketoacidosis (B, weak recommendation)

Question 86: Does metformin cause vitamin B12 deficiency?

Guidelines recommend that patients with diabetes taking metformin for a long time (more than 2 years) or at doses greater than 1 500 mg/day should be routinely screened for vitamin B12 to monitor and prevent vitamin B12 deficiency (A, strongly recommended)

Full guide: http://rs.
yiigle.
com/CN115791202209/1424604.
htm

References: Nutrition and Metabolic Management Branch of China Association for the Promotion of International Exchange in Healthcare, Clinical Nutrition Branch of Chinese Nutrition Society, Diabetes Branch of Chinese Medical Association, etc.
Guidelines for Nutrition Treatment of Diabetes Medicine in China (2022 Edition)[J].
Chinese Journal of Diabetes, 2022, 14(9): 881-933.
DOI: 10.
3760/cma.
j.
cn115791-20220704-00324