diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13050diaendo-13050Research ArticleОбзорыReviewРемиссия сахарного диабета 2 типа: возможности различных стилей питанияRemission of type 2 diabetes: opportunities of different nutrition styleshttps://orcid.org/0000-0003-0143-0849ЕлиашевичС. О.EliashevichS. O.

Елиашевич Софья Олеговна

Москва

Sofia O. Eliashevich

Moscow

elsofol@yandex.ruhttps://orcid.org/0000-0001-5816-3476МишароваА. П.MisharovaA. P.

Мишарова Алина Павловна

101000, Москва, Петроверигский пер., д. 10, стр. 3

Alina P. Misharova

10/3 Petroverigsky Line, Moscow

gggalinamish@mail.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна - д.м.н., профессор, чл.-корр. РАН.

Москва

Oksana M. Drapkina - MD, PhD, Professor, Corresponding Member RAS.

Moscow

ODrapkina@gnicpm.ruНациональный медицинский исследовательский центр терапии и профилактической медициныРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian Federation202406052024272168173Copyright © Елиашевич С.О., Мишарова А.П., Драпкина О.М., 20242024Елиашевич С.О., Мишарова А.П., Драпкина О.М.Eliashevich S.O., Misharova A.P., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13050

За последние несколько десятилетий во многих опубликованных систематических обзорах и метаанализах были обобщены данные о взаимосвязи пищевого поведения, качества рациона и заболеваемости сахарным диабетом 2 типа (СД2). Известно, что более 80% случаев СД2 ассоциировано с ожирением. В связи с этим при формировании целей лечения для пациентов с СД2 алиментарный фактор имеет особое значение. На сегодняшний день болезнь уже не является приговором, т.к. достижение ремиссии СД2 с помощью коррекции питания возможно. Результаты исследований показали, что значимое снижение массы тела является предиктором ремиссии СД2. Однако вопрос о наилучших рекомендациях по коррекции рациона для пациентов с СД2 остается открытым. Различные модели питания (средиземноморская, палеорацион, система DASH и др.) способствуют улучшению гликемии, однако данных, свидетельствующих о регрессии симптомов СД2, недостаточно. По всей вероятности, достижение ремиссии возможно только при существенном сокращении суточной калорийности. Кетогенная модель питания, особенно популярная в последнее время, также способствует улучшению гликемического контроля. В то же время, согласно результатам метаанализа, не стоит пренебрегать углеводами из цельного зерна и злаковых волокон, т.к. данная категория продуктов способствует снижению риска развития СД2.

Last time there are a lot of date, published systematic reviews and meta-analyses about relationship between eating behavior and incidence type 2 diabetes. It is known that more than 80% of cases of type 2 diabetes are associated with obesity. In this regard, the nutritional factor is of particular importance in the formation of treatment goals for patients with type 2 diabetes. Today, the disease is no longer a sentence, because achieving remission of type 2 diabetes is possible with the help of nutritional correction. The results of studies shown that a significant decrease in body weight is a predictor of remission of type 2 diabetes. However, the question of the best dietary recommendations for patients with type 2 diabetes remains open. Various dietary patterns (Mediterranean, paleo diet, DASH system, etc.) contribute to the improvement of glycemia, however, there is not enough data indicating a regression of symptoms of type 2 diabetes. In all likelihood, achieving remission is possible only with a significant reduction in daily caloric intake. The ketogenic diet, especially popular in recent times, also improves glycemic control. At the same time, according to the results of a meta-analysis, carbohydrates from whole grains and cereal fibers should not be neglected, because this category of products helps reduce the risk of developing diabetes.

сахарный диабет 2 типаремиссияпитаниекетогенная модель питаниявегетарианское питаниеdiabetes mellitusinduction of remissiondiet therapyketogenic dietvegetarian dietРабота выполнена по инициативе авторов без дополнительного финансирования.ReferencesFiner S, Robb P, Cowan K, Daly A, et al. Top ten research priorities for type 2 diabetes: results from the Diabetes UK-James Lind Alliance Priority Setting Partnership. Lancet Diabetes Endocrinol. 2017;5:935-936. https://doi.org/10.1016/S2213-8587(17)30324-8Finer S, Robb P, Cowan K, Daly A, et al. Top ten research priorities for type 2 diabetes: results from the Diabetes UK-James Lind Alliance Priority Setting Partnership. Lancet Diabetes Endocrinol. 2017;5:935-936. https://doi.org/10.1016/S2213-8587(17)30324-8International Diabetes Federation. IDF Diabetes Atlas, 2022 Reports. Available from: IDF Diabetes Atlas | Tenth EditionInternational Diabetes Federation. IDF Diabetes Atlas, 2022 Reports. Available from: IDF Diabetes Atlas | Tenth EditionNeuenschwander M, Ballon A, Weber KS, Norat T, et аl. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ. 2019;366:2368. https://doi.org/10.1136/bmj.l2368Neuenschwander M, Ballon A, Weber KS, Norat T, et аl. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ. 2019;366:2368. https://doi.org/10.1136/bmj.l2368Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008;51:1781-9. https://doi.org/10.1007/s00125-008-1116-7Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008;51:1781-9. https://doi.org/10.1007/s00125-008-1116-7Al-Mrabeh A, Zhyzhneuskaya SV, Peters C, et al. Hepatic lipoprotein export and remission of human type 2 diabetes after weight loss. Cell Metab. 2020;31:233-249. https://doi.org/10.1016/j.cmet.2019.11.018Al-Mrabeh A, Zhyzhneuskaya SV, Peters C, et al. Hepatic lipoprotein export and remission of human type 2 diabetes after weight loss. Cell Metab. 2020;31:233-249. https://doi.org/10.1016/j.cmet.2019.11.018American Diabetes Association. Diabetes Care. 2023;46 (Supplement_1):S1–S4. https://doi.org/10.2337/dc23-SintAmerican Diabetes Association. Diabetes Care. 2023;46 (Supplement_1):S1–S4. https://doi.org/10.2337/dc23-SintDavies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;2018(61):2461-2498. https://doi.org/10.1007/s00125-018-4729-5Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;2018(61):2461-2498. https://doi.org/10.1007/s00125-018-4729-5ФГБУ Эндокринологический научный центр МЗ РФ. Алгоритмы оказания медицинской помощи больным сахарным диабетом // Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. — 10-й выпуск. — М.; 2021. https://doi.org/10.14341/DM12802Dedov II, Shestakova MV, Mayorov AY, et al. Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV, Mayorov AYu. 10th edition. Diabetes Mellit. 2022;24(1S):1-148. (in Russ).] https://doi.org/10.14341/DM12802Matthew C Riddle, William T Cefalu, Philip H Evans, et all. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021;44(10):2438–2444. https://doi.org/10.2337/dci21-0034Matthew C Riddle, William T Cefalu, Philip H Evans, et all. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021;44(10):2438–2444. https://doi.org/10.2337/dci21-0034ФГБУ Эндокринологический научный центр МЗ РФ. Алгоритмы оказания медицинской помощи больным сахарным диабетом // Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. — 11-й выпуск. — М.; 2023. https://doi.org/10.14341/DM13042Dedov I, Shestakova M, Mayorov A, et al. Standards of Specialized Diabetes Care / Edited by Dedov II, Shestakova MV, Mayorov A.u. 11th Edition. Diabetes Mellit. 2023;26(2S):1-157 (in Russ). https://doi.org/10.14341/DM13042Wang PY, Fang JC, Gao ZH, et al. Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: a meta-analysis. J Diabetes Investig. 2016;7:56–69. https://doi.org/10.1111/jdi.12376Wang PY, Fang JC, Gao ZH, et al. Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: a meta-analysis. J Diabetes Investig. 2016;7:56–69. https://doi.org/10.1111/jdi.12376Pi-Sunyer X. The Look AHEAD Trial: A Review and Discussion Of Its Outcomes. Curr Nutr Rep. 2014;3(4):387-391. https://doi.org/10.1007/s13668-014-0099-xPi-Sunyer X. The Look AHEAD Trial: A Review and Discussion Of Its Outcomes. Curr Nutr Rep. 2014;3(4):387-391. https://doi.org/10.1007/s13668-014-0099-xLean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7:344-355. https://doi.org/10.1016/S2213-8587(19)30068-3Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7:344-355. https://doi.org/10.1016/S2213-8587(19)30068-3Snorgaard 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. https://doi.org/10.1136/bmjdrc-2016-000354Snorgaard 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. https://doi.org/10.1136/bmjdrc-2016-000354Naude CE, Schoonees A, Senekal M, Young T, et al. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014;9(7):e100652. https://doi.org/10.1371/journal.pone.0100652Naude CE, Schoonees A, Senekal M, Young T, et al. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014;9(7):e100652. https://doi.org/10.1371/journal.pone.0100652Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97(3):505-16. https://doi.org/10.3945/ajcn.112.042457Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97(3):505-16. https://doi.org/10.3945/ajcn.112.042457Goldenberg JZ, Day A, Brinkworth GD, Sato J, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data BMJ. 2021;372:m4743. https://doi.org/10.1136/bmj.m4743Goldenberg JZ, Day A, Brinkworth GD, Sato J, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data BMJ. 2021;372:m4743. https://doi.org/10.1136/bmj.m4743Pramod T, Nidhi SK, Sharma B, Anagha RV, et al. Effectiveness of an Intensive Lifestyle Modification Program on Type 2 Diabetes Remission in Indian Population. Diabetes. 2023;72:1790. https://doi.org/10.2337/db23-1790-PUBPramod T, Nidhi SK, Sharma B, Anagha RV, et al. Effectiveness of an Intensive Lifestyle Modification Program on Type 2 Diabetes Remission in Indian Population. Diabetes. 2023;72:1790. https://doi.org/10.2337/db23-1790-PUBRamesh G, Wood AC, Allison MA, Rich SS, et al. Associations between adherence to the dietary approaches to stop hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). Nutr Metab Cardiovasc Dis. 2022;32(6):1418-1426. https://doi.org/10.1016/j.numecd.2022.03.014Ramesh G, Wood AC, Allison MA, Rich SS, et al. Associations between adherence to the dietary approaches to stop hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). Nutr Metab Cardiovasc Dis. 2022;32(6):1418-1426. https://doi.org/10.1016/j.numecd.2022.03.014Taylor R, Ramachandran A, Yancy WS, Forouhi NG. Nutritional basis of type 2 diabetes remission. BMJ. 2021:374. https://doi.org/10.1136/bmj.n1449Taylor R, Ramachandran A, Yancy WS, Forouhi NG. Nutritional basis of type 2 diabetes remission. BMJ. 2021:374. https://doi.org/10.1136/bmj.n1449Murphy KJ, Parletta N. Implementing a mediterranean-style diet outside the mediterranean region. Curr Atherosclerosis Rep. 2018;20(6):28. https://doi.org/10.1007/s11883-018-0732-zMurphy KJ, Parletta N. Implementing a mediterranean-style diet outside the mediterranean region. Curr Atherosclerosis Rep. 2018;20(6):28. https://doi.org/10.1007/s11883-018-0732-zMayr HL, Tierney AC, Kucianski T, et al. Australian patients with coronary heart disease achieve high adherence to 6-month Mediterranean diet intervention: preliminary results of the AUSMED Heart Trial. Nutrition. 2019;61:21-31. https://doi.org/10.1016/j.nut.2018.10.027Mayr HL, Tierney AC, Kucianski T, et al. Australian patients with coronary heart disease achieve high adherence to 6-month Mediterranean diet intervention: preliminary results of the AUSMED Heart Trial. Nutrition. 2019;61:21-31. https://doi.org/10.1016/j.nut.2018.10.027Keyserling TC, Samuel-odge CD, Pitts SJ, Garcia BA, et al. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: The Heart Healthy Lenoir Project. BMC Publ Health. 2016;16:732. https://doi.org/10.1186/s12889-016-3370-9Keyserling TC, Samuel-odge CD, Pitts SJ, Garcia BA, et al. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: The Heart Healthy Lenoir Project. BMC Publ Health. 2016;16:732. https://doi.org/10.1186/s12889-016-3370-9Itsiopoulos C, Brazionis L, Kaimakamis M, Cameron M, et al. Can he Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomised cross-over study. Nutr Metabol Cardiovasc Dis. 2011; 21 (9):740-747. https://doi.org/10.1016/j.numecd.2010.03.005Itsiopoulos C, Brazionis L, Kaimakamis M, Cameron M, et al. Can he Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomised cross-over study. Nutr Metabol Cardiovasc Dis. 2011; 21 (9):740-747. https://doi.org/10.1016/j.numecd.2010.03.005Vitale M, Masulli M, Calabrese I, Rivellese AA, et al., TOSCA.IT Study Group. Impact of a mediterranean dietary pattern and its components on cardiovascular risk factors, glucose control, and body weight in people with type 2 diabetes: a real-life study. Nutrients. 2018;10(8):1067. https://doi.org/10.3390/nu10081067Vitale M, Masulli M, Calabrese I, Rivellese AA, et al., TOSCA.IT Study Group. Impact of a mediterranean dietary pattern and its components on cardiovascular risk factors, glucose control, and body weight in people with type 2 diabetes: a real-life study. Nutrients. 2018;10(8):1067. https://doi.org/10.3390/nu10081067Ahmad S, Demler OV, Sun Q, Moorthy MV, et al. Association of the mediterranean diet with onset of diabetes in the women’s health study. JAMA Netw Open. 2020;3(11):Article e2025466. https://doi.org/10.1001/jamanetworkopen.2020.25466Ahmad S, Demler OV, Sun Q, Moorthy MV, et al. Association of the mediterranean diet with onset of diabetes in the women’s health study. JAMA Netw Open. 2020;3(11):Article e2025466. https://doi.org/10.1001/jamanetworkopen.2020.25466Esposito K, Giugliano D. Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev. 2014;30:34-40. https://doi.org/10.1002/dmrr.2516Esposito K, Giugliano D. Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev. 2014;30:34-40. https://doi.org/10.1002/dmrr.2516Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015(69):1200:1208. https://doi.org/10.1038/ejcn.2014.243Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015(69):1200:1208. https://doi.org/10.1038/ejcn.2014.243Esposito K, Maiorino MI, Bellastella G, Chiodini P, et al. A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open. 2015;5(8):Article e008222. https://doi.org/10.1136/bmjopen-2015-008222Esposito K, Maiorino MI, Bellastella G, Chiodini P, et al. A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open. 2015;5(8):Article e008222. https://doi.org/10.1136/bmjopen-2015-008222Masharani U, Sherchan P, Schloetter M, et al. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015;69;944–948. https://doi.org/10.1038/ejcn.2015.39Masharani U, Sherchan P, Schloetter M, et al. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015;69;944–948. https://doi.org/10.1038/ejcn.2015.39Aune D, Norat T, Romundstad P, et al. Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol. 2013;28:845–858. https://doi.org/10.1007/s10654-013-9852-5Aune D, Norat T, Romundstad P, et al. Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol. 2013;28:845–858. https://doi.org/10.1007/s10654-013-9852-5Ahmadi-Abhari S, Luben RN, Powell N, Bhaniani A. et al. Dietary intake of carbohydrates and risk of type 2 diabetes: the European Prospective Investigation into Cancer-Norfolk study. Br J Nutr. 2014;111(2):342-52. https://doi.org/10.1017/S0007114513002298Ahmadi-Abhari S, Luben RN, Powell N, Bhaniani A. et al. Dietary intake of carbohydrates and risk of type 2 diabetes: the European Prospective Investigation into Cancer-Norfolk study. Br J Nutr. 2014;111(2):342-52. https://doi.org/10.1017/S0007114513002298

The authors declare that there are no conflicts of interest present.