Changes in dietary management of diabetic patients.

In the late 1990s, diet remains the cornerstone of diabetes therapy. Dietar y and nutritional recommendations should seek to reduce the hyperglycaemic state which is the main risk factor for microangiopathy. Furthermore, the p revention of macrovascular complications should lead to dietary prescriptio ns that combine such properties as antiatherosclerotic, antithrombotic, and antihypertensive measures and such advantages as reducing oxidative stress . The means for achieving such objectives are, first, weight-loss intervent ions in obese patients and,secondly, the choice of a judicious balance betw een carbohydrates and monounsaturated fats in ail individuals. Dietary meas ures must achieve a compromise between their acceptability by the patient a nd medical requirements. For that reason, caloric restriction should he mod erate, leading to progressive weight loss (- 3 kg monthly), with reasonable weight targets at the end of the weight-reduction period. Compliance with dietary advice usually results in significant savings in medical costs. How ever, long-term maintenance of dietary measures is difficult to achieve in most individuals, except those enroled in well-structured training programm es.