Diet and Exercise in the Prevention and Treatment of Diabetes Mellitus: Time to Get Back to Basics

The prevalence of diabetes all over the world is increasing along with the prevalence of obesity. There are currently approximately 30 million Americans and up to 350 million patients worldwide with diabetes mellitus (DM). We have more than 30 different medications in 11 classes of drugs to manage Type I and Type II DM. There were only a few drugs available when I was in medical school in the 1970’s, and all medical text books emphasized diet and exercise as first line treatment for Type II DM patients. I believe diet and exercise should still be emphasized as the first line of diabetic treatment,and as patients transition from healthy diet and exercise to the addition of medications in order to optimize glycemic control, nutrition and exercise should continue to be an essential component of the treatment plan. New ADA guidelines recommend for the first time that patients with diabetes should limit or avoid super sweetened beverages from any caloric sweetener including high fructose corn syrup and sucrose. The carbohydrates in diabetic patients’ diets should come from vegetables, whole grains, fruits, legumes, and dairy products. A recent multi-center trial in Spain by J. Salas-Salvadóet al confirmed that a Mediterranean diet supplemented with extra virgin olive oil decreased 40% relative reduction in diabetes risk compared with the control group [1]. The subjects in this study had a median 4.1 years of follow up.