The role of carbohydrate in diabetes management

The role of carbohydrate in the diet of people living with diabetes is an area of much debate. This relates to both type and quantity of carbohydrate consumed, with low carbohydrate diets increasing in popularity. However, it is important to take a whole diet approach and not just in terms of single nutrients. This review considers what carbohydrates are and how recommendations for people with diabetes might differ from those for the general population. There are no obligate requirements for dietary carbohydrate. UK recommendations suggest 50% of total energy should come from carbohydrate for the general population; however, evidence does not support an optimal carbohydrate intake for people living with diabetes. Equally, there is no evidence to support a change in other macronutrient intakes including fat; thereby challenging the perspective of low carbohydrate diet advocates, which may encourage higher saturated fat intakes. Carbohydrate quality is important in terms of glycaemic index and fibre, and may have other health benefits; however, the quantity of carbohydrate is a more important predictor of glycaemic response. People with type 1 diabetes can improve the accuracy of insulin dosing with carbohydrate counting and technology may also have a role to play in this, with the introduction of bolus advisor meters. There is no universal recommendation for the amount of carbohydrate for people living with diabetes. Recommendations should therefore be based on personal preference, individual glycaemic response and other health targets, ideally with the support of a registered dietitian specialising in diabetes. Copyright © 2016 John Wiley & Sons.