Proper nutrition is a critical component of managing diabetes, as the foods we consume directly impact our blood sugar levels. By making informed choices about what and how we eat, individuals with diabetes can better control their condition and reduce the risk of complications. One key aspect of this is employing smart food preparation methods that help maintain stable blood glucose, provide essential nutrients, and support overall health.
In this article, we will explore a range of clever cooking techniques and strategies that every diabetic should know. From understanding the glycemic impact of different foods to mastering portion control and meal planning, we will provide practical tips and insights to help you optimize your diet and manage your diabetes more effectively. Whether you are newly diagnosed or have been living with diabetes for years, these smart food prep methods can empower you to take control of your health and enjoy delicious, nourishing meals every day.
Understanding Diabetes and Its Impact on Diet
Diabetes is a chronic metabolic disorder characterized by high blood sugar levels resulting from either a lack of insulin production (Type 1 diabetes) or the body’s inability to effectively use insulin (Type 2 diabetes). Insulin, a hormone produced by the pancreas, plays a crucial role in regulating blood sugar by enabling cells to absorb glucose from the bloodstream[1].
Types of Diabetes
Type 1 diabetes is an autoimmune condition in which the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. As a result, individuals with Type 1 diabetes require daily insulin injections to manage their blood sugar levels. On the other hand, Type 2 diabetes develops when the body becomes resistant to insulin or doesn’t produce enough insulin to maintain normal glucose levels. This type is more common and often associated with lifestyle factors such as obesity and physical inactivity[2].
Blood Sugar Regulation
Maintaining stable blood sugar levels is essential for preventing both short-term and long-term complications of diabetes. When blood sugar levels remain consistently high, it can lead to damage in various organs and tissues, including the eyes, kidneys, nerves, and cardiovascular system. Conversely, low blood sugar (hypoglycemia) can cause immediate symptoms such as dizziness, confusion, and loss of consciousness[3].
Importance of Proper Nutrition
Diet plays a vital role in managing diabetes, as the foods we consume directly impact blood sugar levels. Carbohydrates, in particular, have the most significant effect on glucose levels, as they are broken down into sugar during digestion. By making informed choices about the types and amounts of carbohydrates consumed, individuals with diabetes can better control their blood sugar and reduce the risk of complications.
Glycemic Index and Glycemic Load
The glycemic index (GI) is a measure of how quickly a particular food raises blood sugar levels compared to pure glucose. Foods with a high GI cause rapid spikes in blood sugar, while those with a low GI result in a slower, more gradual increase. The glycemic load (GL) takes into account both the GI and the amount of carbohydrates in a serving of food, providing a more comprehensive picture of its impact on blood sugar. By focusing on low-GI and low-GL foods, diabetics can help maintain stable glucose levels and improve overall diabetes management.
Essential Nutrients for Diabetics
A well-balanced diet that includes a variety of essential nutrients is crucial for individuals with diabetes to maintain optimal health and manage their condition effectively. While all macronutrients (carbohydrates, proteins, and fats) play important roles, it’s essential to understand their impact on blood sugar levels and overall well-being.
Carbohydrates
Carbohydrates are the primary nutrient that affects blood sugar levels. They are broken down into glucose during digestion, which is then absorbed into the bloodstream. It’s important for diabetics to monitor both the quantity and quality of carbohydrates consumed. Complex carbohydrates, such as those found in whole grains, legumes, and vegetables, are preferred over simple carbohydrates like refined sugars and processed foods, as they provide a slower, more sustained release of glucose[4].
Proteins
Proteins are essential for building and repairing tissues, as well as maintaining muscle mass. They have a minimal impact on blood sugar levels compared to carbohydrates. However, it’s important to choose lean protein sources, such as poultry, fish, and plant-based options, to limit the intake of saturated fats, which can contribute to cardiovascular disease – a common complication of diabetes[5].
Pros | Cons |
---|---|
Lean proteins (poultry, fish) are low in saturated fats | Some protein sources (red meat) are high in saturated fats |
Plant-based proteins (legumes, tofu) are high in fiber | Processed meats often contain added sodium and preservatives |
Proteins have minimal impact on blood sugar levels | Excessive protein intake may strain the kidneys |
Fats
Fats are an important source of energy and help with the absorption of fat-soluble vitamins. However, not all fats are created equal. Unsaturated fats, such as those found in nuts, seeds, avocados, and fatty fish, are considered healthy and can help lower cholesterol levels. On the other hand, saturated and trans fats, often found in fried foods, processed snacks, and animal products, can contribute to insulin resistance and increase the risk of heart disease[6].
Vitamins and Minerals
Micronutrients, including vitamins and minerals, play crucial roles in maintaining overall health and supporting various bodily functions. For example, vitamin D helps with calcium absorption and bone health, while magnesium is involved in insulin secretion and glucose metabolism. Diabetics should aim to obtain these essential nutrients through a balanced diet that includes a variety of fruits, vegetables, whole grains, and lean protein sources.
Fiber
Dietary fiber, found in plant-based foods, is an important component of a diabetic-friendly diet. Fiber helps slow down the absorption of glucose, promoting more stable blood sugar levels. It also aids in digestion, supports healthy gut bacteria, and contributes to feelings of fullness, which can assist with weight management. High-fiber foods include fruits, vegetables, whole grains, legumes, and nuts.
Healthy Food Choices for Diabetics
Making healthy food choices is a key component of managing diabetes effectively. By focusing on nutrient-dense, low-glycemic foods, diabetics can help stabilize their blood sugar levels, maintain a healthy weight, and reduce the risk of complications. Here are some essential food groups and specific choices that should be prioritized in a diabetic-friendly diet.
Fruits and Vegetables
Fruits and vegetables are rich in vitamins, minerals, antioxidants, and dietary fiber. They should form the foundation of a healthy diet for diabetics. However, it’s important to be mindful of portion sizes and choose lower-sugar options. Non-starchy vegetables like leafy greens, broccoli, cauliflower, and bell peppers are excellent choices, as they have minimal impact on blood sugar levels. Fruits with a lower glycemic index, such as berries, apples, and citrus fruits, are also good options when consumed in moderation[7].
Whole Grains
Whole grains are an important source of complex carbohydrates, fiber, and essential nutrients. Unlike refined grains, which have been stripped of their bran and germ, whole grains retain these nutrient-rich components. Examples of whole grains include brown rice, quinoa, oats, whole wheat, and barley. These foods provide a slower, more sustained release of glucose into the bloodstream, helping to maintain stable blood sugar levels[8].
Fiber | Vitamins and Minerals | Glycemic Impact | |
---|---|---|---|
Whole Grains | High | High | Lower |
Refined Grains | Low | Low | Higher |
Lean Proteins
Protein is essential for maintaining muscle mass, supporting immune function, and promoting satiety. Diabetics should focus on lean protein sources to minimize the intake of saturated fats, which can contribute to cardiovascular disease. Good options include skinless poultry, fish, legumes, tofu, and low-fat dairy products. Plant-based proteins, such as beans and lentils, have the added benefit of being high in fiber, which can help with blood sugar control[9].
Healthy Fats
While diabetics should be mindful of their overall fat intake, incorporating healthy fats into the diet is important for heart health and overall well-being. Monounsaturated and polyunsaturated fats, found in sources like nuts, seeds, avocados, olive oil, and fatty fish, can help lower LDL cholesterol levels and reduce inflammation. These fats should be used in place of saturated and trans fats, which can negatively impact insulin sensitivity and cardiovascular health.
- Choose fresh, whole foods over processed and packaged options
- Read nutrition labels to monitor carbohydrate content and serving sizes
- Incorporate a variety of colorful fruits and vegetables into meals and snacks
Smart Food Preparation Techniques
In addition to choosing healthy foods, the way in which meals are prepared can significantly impact the nutritional value and suitability for a diabetic-friendly diet. By employing smart food preparation techniques, diabetics can maximize the benefits of their food choices and minimize the negative effects on blood sugar levels.
Grilling and Roasting
Grilling and roasting are excellent cooking methods for diabetics, as they require little to no added fats. These techniques allow for the natural flavors of foods to shine through, reducing the need for high-calorie sauces or seasonings. When grilling or roasting meats, it’s important to trim excess fat and choose leaner cuts to limit saturated fat intake. Vegetables can also be grilled or roasted to enhance their flavor and texture, making them more appealing and enjoyable to eat[10].
Steaming and Boiling
Steaming and boiling are simple, healthy cooking methods that help retain the nutrients in foods, particularly vegetables. These techniques do not require added fats, making them ideal for diabetics looking to manage their weight and control blood sugar levels. Steaming is particularly effective in preserving water-soluble vitamins, such as vitamin C and B-vitamins, which can be lost when cooking in water[11]. When boiling, it’s best to use minimal water and avoid overcooking to prevent nutrient loss.
Stir-Frying and Sautéing
Stir-frying and sautéing are quick cooking methods that use small amounts of healthy oils, such as olive oil or coconut oil, to cook foods over high heat. These techniques are well-suited for preparing vegetables, lean proteins, and whole grains in a flavorful and nutritious way. When stir-frying or sautéing, it’s essential to choose oils with high smoke points and to use them sparingly to keep calorie and fat intake in check. Adding herbs, spices, and low-sodium seasonings can enhance the flavor of dishes without relying on high-calorie sauces[12].
Baking and Air Frying
Baking and air frying are healthier alternatives to deep-frying, as they require little to no added oils. These methods can be used to prepare a variety of foods, from lean proteins and vegetables to whole-grain breads and desserts. When baking, it’s important to monitor portion sizes and choose recipes that use whole-grain flours, natural sweeteners, and healthy fats. Air frying allows for the creation of crispy, flavorful dishes with significantly less oil compared to traditional deep-frying, making it a great option for diabetics looking to satisfy their cravings for crunchy textures.
- Experiment with different cooking methods to find what works best for your preferences and lifestyle.
- Plan and prepare meals in advance to ensure you always have healthy options on hand.
- Involve family members or friends in meal preparation to make the process more enjoyable and sustainable.
Portion Control and Meal Planning
Effective portion control and meal planning are essential components of managing diabetes through diet. By understanding appropriate serving sizes and creating well-balanced meals, diabetics can better regulate their blood sugar levels and maintain a healthy weight.
Understanding Portion Sizes
Portion sizes have increased significantly over the years, contributing to the rise in obesity and related health problems, including diabetes. To effectively manage diabetes, it’s crucial to understand what constitutes a proper portion size for various food groups. Visual cues, such as using the plate method or comparing serving sizes to common household objects, can be helpful in estimating appropriate portions[13]. For example, a serving of lean protein should be about the size of a deck of cards, while a serving of cooked vegetables should be about the size of a baseball.
Creating Balanced Meals
A well-balanced meal should include a combination of nutrient-dense foods from various food groups, with a focus on complex carbohydrates, lean proteins, healthy fats, and non-starchy vegetables. The plate method is a simple and effective way to create balanced meals, ensuring that half of the plate is filled with non-starchy vegetables, one-quarter with lean proteins, and one-quarter with complex carbohydrates[14]. This approach helps to control carbohydrate intake while providing essential nutrients and promoting satiety.
Meal | Foods |
---|---|
Breakfast | Oatmeal with berries and nuts, hard-boiled egg |
Lunch | Grilled chicken salad with mixed greens, avocado, and vinaigrette |
Dinner | Baked fish, roasted vegetables, quinoa |
Snacks | Greek yogurt with chia seeds, carrot sticks with hummus |
Meal Planning and Preparation
Planning and preparing meals in advance can help diabetics stay on track with their dietary goals and avoid impulsive food choices. By dedicating time each week to plan meals, create a grocery list, and prepare food in advance, diabetics can ensure they always have healthy options readily available[15]. This can be particularly beneficial for those with busy schedules or limited time for cooking.
Some strategies for successful meal planning and preparation include:
- Batch cooking and freezing portions for later use
- Prepping ingredients, such as washing and chopping vegetables, in advance
- Utilizing slow cookers or instant pots for easy, hands-off meal preparation
- Keeping a well-stocked pantry with healthy staples, such as whole grains, legumes, and low-sodium canned goods
Managing Blood Sugar Levels through Food Prep
One of the primary goals of a diabetic-friendly diet is to maintain stable blood sugar levels throughout the day. By incorporating specific strategies into food preparation, diabetics can better control their glucose levels and reduce the risk of complications associated with blood sugar fluctuations.
Understanding the Glycemic Index
The glycemic index (GI) is a measure of how quickly a food raises blood sugar levels. Foods with a high GI, such as refined carbohydrates and sugary snacks, cause rapid spikes in blood glucose, while low-GI foods, like whole grains, non-starchy vegetables, and legumes, result in a slower, more gradual rise in blood sugar[16]. When preparing meals, diabetics should prioritize low-GI foods to help maintain stable blood sugar levels. Combining high-GI foods with protein, healthy fats, or fiber can also help slow glucose absorption and minimize blood sugar spikes.
Timing of Meals and Snacks
The timing of meals and snacks can also play a significant role in managing blood sugar levels. Eating regular, well-balanced meals throughout the day helps maintain stable glucose levels and prevents excessive hunger, which can lead to overeating or poor food choices. Diabetics should aim to eat every 3-4 hours, with a focus on nutrient-dense, low-GI foods at each meal[17]. Incorporating healthy snacks between meals can also help prevent blood sugar dips and maintain energy levels.
Time | Meal/Snack |
---|---|
7:00 AM | Breakfast |
10:00 AM | Morning Snack |
1:00 PM | Lunch |
4:00 PM | Afternoon Snack |
7:00 PM | Dinner |
10:00 PM | Evening Snack (if needed) |
Monitoring Blood Sugar Response
Every individual’s blood sugar response to specific foods can vary, making it essential for diabetics to monitor their glucose levels regularly. By keeping a food and blood sugar log, diabetics can identify how different meals and snacks affect their blood sugar and make adjustments accordingly[18]. This information can be used to fine-tune meal planning and preparation, ensuring that blood sugar levels remain within a healthy range.
Some strategies for monitoring blood sugar response include:
- Testing blood sugar before and 2 hours after meals
- Noting the types and quantities of foods consumed at each meal
- Identifying patterns or triggers that lead to blood sugar fluctuations
- Consulting with a healthcare provider or registered dietitian to interpret results and make necessary adjustments to the diet plan
Adapting Recipes for Diabetic-Friendly Meals
Many traditional recipes can be high in sugar, refined carbohydrates, and unhealthy fats, making them unsuitable for a diabetic-friendly diet. However, with a few simple modifications, these recipes can be adapted to create delicious, nutritious meals that support blood sugar management.
Reducing Sugar and Carbohydrates
One of the primary ways to adapt recipes for diabetics is to reduce the amount of sugar and refined carbohydrates. This can be achieved by substituting whole-grain options for refined flours, using natural sweeteners like stevia or monk fruit in place of sugar, and reducing the overall quantity of sweeteners used[19]. In baked goods, applesauce, mashed bananas, or pureed dates can be used as natural sweeteners and moisture-enhancers, while also providing additional nutrients and fiber.
Increasing Fiber and Protein
Incorporating more fiber and protein into recipes can help slow the absorption of glucose, promoting more stable blood sugar levels. This can be done by adding vegetables, legumes, and whole grains to dishes, as well as using lean proteins like chicken, fish, or tofu[20]. For example, traditional pasta dishes can be made more diabetic-friendly by using whole-grain or legume-based pasta, increasing the proportion of non-starchy vegetables, and opting for a lean protein source.
Traditional Recipe | Diabetic-Friendly Adaptation |
---|---|
Beef lasagna | Zucchini lasagna with lean ground turkey and low-fat cheese |
Fried chicken | Oven-baked chicken with almond flour coating |
Chocolate chip cookies | Oatmeal cookies with dark chocolate chips and reduced sugar |
Mashed potatoes | Mashed cauliflower with garlic and low-fat milk |
Modifying Cooking Methods
In addition to adjusting ingredients, modifying cooking methods can also make recipes more diabetic-friendly. Grilling, baking, roasting, and stir-frying with healthy oils are preferable to deep-frying or cooking with excessive amounts of butter or cream[21]. These healthier cooking methods help reduce the overall calorie and fat content of meals while still allowing for flavorful and satisfying dishes.
Some tips for modifying cooking methods include:
- Using non-stick cookware to minimize the need for added oils
- Marinating meats and vegetables to add flavor without relying on high-calorie sauces
- Utilizing herbs, spices, and citrus to enhance the natural flavors of foods
- Experimenting with plant-based cooking techniques, such as braising or simmering, to create hearty, flavorful meals with less meat
Maintaining a Healthy Lifestyle as a Diabetic
While a balanced, nutritious diet is a cornerstone of diabetes management, it is just one aspect of maintaining a healthy lifestyle. Incorporating regular physical activity, managing stress, and getting sufficient sleep are also crucial for overall well-being and blood sugar control.
The Importance of Regular Exercise
Exercise plays a vital role in diabetes management by improving insulin sensitivity, helping to maintain a healthy weight, and reducing the risk of cardiovascular complications. The American Diabetes Association recommends that diabetics engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, spread over at least three days[22]. Examples of suitable activities include brisk walking, cycling, swimming, and dancing. Resistance training, such as weightlifting or bodyweight exercises, should also be performed at least two days per week to build and maintain muscle mass, which can further improve insulin sensitivity.
Stress Management Techniques
Chronic stress can lead to elevated blood sugar levels, as stress hormones like cortisol can interfere with insulin function. Effective stress management is essential for maintaining stable glucose levels and overall well-being. Some proven stress-reduction techniques include deep breathing exercises, progressive muscle relaxation, mindfulness meditation, and engaging in enjoyable hobbies or activities[23]. Regular exercise can also help reduce stress and improve mood by releasing endorphins, the body’s natural stress-busters.
Technique | Description |
---|---|
Deep breathing | Taking slow, deep breaths to promote relaxation and reduce tension |
Progressive muscle relaxation | Systematically tensing and relaxing muscle groups to release stress |
Mindfulness meditation | Focusing on the present moment and observing thoughts and sensations without judgment |
Engaging in hobbies | Pursuing enjoyable activities that promote a sense of accomplishment and relaxation |
The Role of Sleep in Diabetes Management
Getting sufficient, high-quality sleep is crucial for maintaining proper insulin function and blood sugar control. Sleep deprivation can lead to insulin resistance, increased appetite, and cravings for high-carbohydrate foods, all of which can negatively impact diabetes management[24]. Diabetics should aim for 7-9 hours of sleep per night and practice good sleep hygiene, such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and ensuring a comfortable sleep environment.
Some tips for improving sleep quality include:
- Avoiding caffeine, alcohol, and large meals close to bedtime
- Limiting exposure to electronic devices and bright lights before bed
- Engaging in regular exercise, but not too close to bedtime
- Managing stress through relaxation techniques or cognitive-behavioral therapy
Frequently Asked Questions
The best diet for diabetics is one that focuses on whole, minimally processed foods, including non-starchy vegetables, lean proteins, healthy fats, and controlled portions of complex carbohydrates. Consultation with a registered dietitian can help create a personalized meal plan that takes into account individual preferences, lifestyle, and blood sugar management goals.
Yes, diabetics can eat fruit as part of a balanced diet. However, it’s essential to choose fruits with a lower glycemic index, such as berries, citrus fruits, and apples, and to monitor portion sizes. Pairing fruit with a source of protein or healthy fat can help slow glucose absorption and prevent blood sugar spikes.
Diabetics should aim to eat regular, well-balanced meals every 3-4 hours to maintain stable blood sugar levels throughout the day. This typically includes three main meals and 1-2 snacks, depending on individual needs and preferences. Consistent meal timing can help prevent excessive hunger, overeating, and blood sugar fluctuations.
While no single food needs to be avoided entirely, diabetics should limit or minimize their intake of foods high in added sugars, refined carbohydrates, and unhealthy fats. These include sugary beverages, candy, baked goods, processed snacks, and fried foods. Moderation and portion control are key when consuming these types of foods.
To manage cravings for high-carb or sugary foods, diabetics can try several strategies, such as choosing healthier alternatives (e.g., fresh fruit instead of candy), practicing mindful eating, and finding non-food ways to cope with stress or emotions. Planning meals and snacks in advance and keeping healthy options readily available can also help reduce the likelihood of giving in to cravings.
Diabetics can generally consume alcohol in moderation, which means up to one drink per day for women and up to two drinks per day for men. However, it’s crucial to monitor blood sugar levels closely, as alcohol can interfere with glucose metabolism and lead to hypoglycemia. Diabetics should also be aware of the carbohydrate content of various alcoholic beverages and mixers, and avoid consuming alcohol on an empty stomach.
Regular exercise is an essential component of a diabetic-friendly lifestyle, as it helps improve insulin sensitivity, maintain a healthy weight, and reduce the risk of cardiovascular complications. Diabetics should aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with resistance training at least twice a week. Consultation with a healthcare provider is recommended before starting a new exercise program.
Reference list
- American Diabetes Association. Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S1-S232.
- Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019;42(5):731-754.
- Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. J Acad Nutr Diet. 2017;117(10):1659-1679.
- Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383(9933):1999-2007.
- Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol. 2018;33(2):157-170.
- Papamichou D, Panagiotakos DB, Itsiopoulos C. Dietary patterns and management of type 2 diabetes: A systematic review of randomised clinical trials. Nutr Metab Cardiovasc Dis. 2019;29(6):531-543.
- Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open. 2015;5(8):e008222.
- Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014;4(5):373-382.
- Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5(1):e000354.
- van Zuuren EJ, Fedorowicz Z, Kuijpers T, Pijl H. Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments. Am J Clin Nutr. 2018;108(2):300-331.
- Korsmo-Haugen HK, Brurberg KG, Mann J, Aas AM. Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab. 2019;21(1):15-27.
- Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;139:239-252.
- Tay J, Thompson CH, Luscombe-Marsh ND, et al. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab. 2018;20(4):858-871.
- Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551.
- Hallberg SJ, McKenzie AL, Williams PT, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018;9(2):583-612.
- Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front Endocrinol (Lausanne). 2019;10:348.
- Shai I, Schwarzfuchs D, Henkin Y, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. N Engl J Med. 2008;359(3):229-241.
- Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018;378(25):e34.
- Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract. 2016;22 Suppl 3:1-203.
- Hamdy O, Mottalib A, Morsi A, et al. Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study. BMJ Open Diabetes Res Care. 2017;5(1):e000259.
- Colberg SR, Sigal RJ, Yardley JE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079.
- Surwit RS, van Tilburg MA, Zucker N, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care. 2002;25(1):30-34.
- Chasens ER, Korytkowski M, Sereika SM, Burke LE. Effect of poor sleep quality and excessive daytime sleepiness on factors associated with diabetes self-management. Diabetes Educ. 2013;39(1):74-82.