Dietary intervention, education on lifestyle strategies needed to combat diabetes

by DR AMUTHA RAMADAS / pic BLOOMBERG

THE International Diabetes Federation (IDF, 2021) recently acknowledged that diabetes is one of this century’s fastest-growing global health crises. 

An estimated 537 million adults between 20 and 79 around the world are living with diabetes with more than 75% living in middle to low-income countries. This figure is expected to rise steadily in the coming years.

Ninety million adults in South-East Asia are living with diabetes and sadly, one out of two of these adults are undiagnosed. In 2021, Malaysia was one of the top five countries with adults battling diabetes in the Western Pacific region at 4.4 million. This public health concern has prompted the development of the National Strategic Plan for non-communicable diseases (2015–2025) with specific targets to halt obesity and diabetes.

Dietary intervention is one of the cornerstones of diabetes management. However, the adherence to lifestyle recommendations given to individuals with diabetes in Malaysia remains poor. This remains an area that requires active investigation and novel solutions. 

Another critical point to be considered is the rising prevalence of prediabetes in this country. Pooled analysis showed that the prevalence of prediabetes in Malaysia stands at 11.6%.

While it is imperative to prevent diabetes to prevent future complications, it is also beneficial in reducing the individual and national economic burden in terms of healthcare expenses. Therefore, it is of utmost importance that measures are taken to prevent prediabetes from progressing to overt diabetes. 

Local studies showed that while individuals with diabetes have good diet quality, likely due to active dietary interventions by healthcare professionals, individuals with prediabetes are at greater risk of having poor diet quality.

Nutritional interventions are pivotal in preventing prediabetes from advancing to overt diabetes. These strategies ranged from specific nutrient supplements to combined diets incorporating an amalgamation of food types. Our review of dietary interventions for prediabetes found that two-thirds of the studies experimented on one food group or selected food type, rather than combination diets such as low-fat or low-carbohydrate diets. 

An all-encompassing dietary regimen also lacks feasibility when considering inter-individual variability. This phenomenon can be attributed to differences in gut microbiota, genetic polymorphisms for intestinal transport proteins and various host factors such as age, sex and metabolic status. Hence, a “one-size-fits-all” approach to dietary management of prediabetes may not be favourable.

We also found that one-third of the interventions focused on providing dietary education rather than a closed experimental setting with strict observers. Commonly administered by a registered dietitian or nutritionist, these education-based interventions involved multiple follow-ups and regular dietary reviews to ensure compliance. The implementation of nutritional education has the potential to exert not only long-term health impact on participants, but also reflect real-world feasibility — an aspect not usually seen in noneducational nutritional interventions.

Considering the severe diabetes burden in our country, it is getting more apparent that the prediabetic state represents a golden opportunity for preventive strategies. The poorer diet quality of prediabetic Malaysians and the lack of evidence on effective local intervention programmes in this group is a great concern. 

Moving forward, stakeholders, including the Ministry of Health, NGOs, nutrition researchers and healthcare professionals, may need to explore potential interventions focusing on dietary and lifestyle strategies suitable for local communities.

  • Dr Amutha Ramadas is a senior lecturer at the Jeffrey Cheah School of Medicine & Health Sciences at Monash University Malaysia.