**4. Dietary diversity**

**2. Dietary and behavioral changes**

4 Diabetes Food Plan

incidence and propagation of the disease.

**the incidence of diabetes**

Medical nutrition therapy is an important intervention of diabetes care. This is also of significant when it comes to diabetes self-management, education, and training. When it comes to nutrition, the first priority for individuals requiring insulin therapy is to change their lifestyle so that an insulin regimen is incorporated into their preferred diet and exercise routines.

Despite its importance, there is relatively little evidence on how dietary behavior changes after diagnosis. On average, weight loss after diagnosis is fairly limited. At the same time, there is considerable heterogeneity in this aspect, with some individuals losing more weight and having better clinical outcomes than others. Also, since food products are consumed in combination and nutrients metabolized altogether, it might be more difficult to estimate the associations between individual foods or nutrients and disease incidence compared with the collective approach. Despite these shortcomings of associating diet and diabetes, there have been several aspects, which have been conversed among scientists in relation to prevent the

Lifestyle modifications are an integral part of diabetes management and are generally recommended interventions for most diabetic patients. In fact, it is strongly believed that the treatment of diabetes should start with nonpharmacological therapies such as lifestyle interventions. It is construed as a result of an individual motivation and knowledge, based on personal initiative and responsibility. This focus, however, tends to neglect the relevance of contextual factors. Additionally, for most systematic and scientific studies in this aspect, diabetes duration is an imprecise entity and some individuals participating in such evaluations may have a prolonged period of unrecognized hyperglycemia preceding a diagnosis. For instance, self-management involves complex interactions among people diagnosed with diabetes, involving networks and the broader community [2]. As such, it is recognized that

Out of all diets recommended for diabetes, plant-based diets have received the greatest amount of attention for their use in a variety of diseases such as the management of cancer, cardiovascular disease, obesity, hypertension, and type 2 diabetes mellitus [3, 4]. A plantbased diet is specifically defined as "a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs as well as all refined and processed foods" [5]. Inadequate consumption of fruits and vegetables in particular, is estimated to contribute to 5% of excess mortality globally [6]. A recent prospective study in the EPIC cohort indicated that consuming a higher number of different items within the fruit (0–58) and/or vegetable (0–59) food groups was associated with a reduced risk of type 2 diabetes [7]. There are various types of plant-based diets being followed throughout the world, out of which the Mediterranean diet has received much attention recently. This diet is discussed in detail in the next section.

**3. The Mediterranean diet as a plausible intervention for preventing** 

The Mediterranean diet is the most widely discussed and historically significant plant-based diets of all. The Mediterranean diet is a homogeneous and straightforward construct having

health-promoting initiatives seldom reach those who need them the most.

Many national and international policies and authorities have recognized the importance of a healthy balanced diet, and numerous dietary guidelines have been issued to emphasize the critical role of the consumption of a diet widely varies to include different types of food products coming from different food groups [6, 14–18]. Although a greater intake of different food subtypes (collectively referred as minor food groups) from each major food group is crucial for nutritional adequacy, indices of diet quality rarely include a measure of dietary diversity and none address variety within food groups other than for fruits and vegetables [19–22].

More recently, analysis in a multiethnic cohort concluded that a higher number of different food items (between 0 and 120) consumed at least twice a week was not associated with incident type 2 diabetes [23]. It is possible that a diet comprising of all five major food groups could still depend on the consumption of a comparatively slender range of foods within each group [19]. In this sense, it would be best if a higher overall diversity is maintained at the major food group consumption level, but with less variation in terms of different subtypes of foods. It is suggested in the review by Conklin et al. [19], that despite common advice recommended to consume a varied diet [6, 15, 18], it was not obvious whether studies have investigated how the number of different food groups and different subtypes within each food group included in a diet are associated with the risk of contracting diabetes. Nevertheless, the findings by Conklin et al. [19] supported many of the current public health recommendations, which encourage the consumption of all major food groups and also other different types of fruits, vegetables, and dairy products as part of a regular balanced diet. However, it has to be borne in mind that the additional costs of greater diversity require a comprehensive food pricing strategy as well [19].

[31–33]. The modulation of the immune system by the gut microbiota essentially begins even before birth. It is obvious that the intrauterine environment of the fetus during pregnancy is not completely sterile. There is evidence that the placenta of a term pregnancy has many nonpathogenic commensal microbiota in low-abundance, similar to the oral microbiome of nonpregnant women [31]. Following birth, diet, and microbiota are the decisive factors that

Introductory Chapter: The Need for Dietary Interventions for Diabetes

http://dx.doi.org/10.5772/intechopen.72897

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Dietary antigens, especially those associated with type 1 diabetes, depend on early feeding regimens, the age of introduction of foods, especially wheat, to the infant's diet, and the current consumption of nutrients [34, 35]. Understanding and hypothesizing that the gut microbiota is an organ will make it possible to integrate its relationship with diabetes as a key for designing new therapies to prevent and/or improve the control and propagation of the disease. Dietary components provide different substrates, which may ultimately result in several products during the fermentation processes. Changes in the structure of the microbiota due to dietary modifications are because some of the bacterial communities are "genetically better

A multicomponent-based lifestyle enabling the prevention of diabetes, which includes diet and both aerobic and resistance exercise training, is generally regarded as the most effective in inducing weight loss and improving impaired fasting glucose, glucose tolerance, dietary, and exercise outcomes in at-risk and prediabetic adult populations. Several scientific studies support the current dietary and exercise guidelines for the inclusion of resistance training in type 2 diabetes prevention. However, when it comes to exercise and other physical workouts, there remains an urgent need for more rigorous studies, with long-term follow-up evaluating program efficacy, muscular fitness outcomes, diabetes

Overall, a low-carbohydrate diet score has been significantly associated with a decreased risk of diabetes. This association is attenuated through adjustment of the glycemic load. The composition of the gut microbiota is also believed to be related to diabetes prevention especially since it can be modulated by diet. This modulation can promote the proper maturation of the immune system or result in gut dysbiosis and aberrant immune responses, which can eventu-

People who live their lives with their diabetes are interconnected with their multilevel network and it has been observed that they adapt the illness to their life, not the opposite. In terms of the psychology of being contracted with this disease, to meet a sustainable network approach, thus involves wide encounters encompassing life factors at different levels. All social, political, and cultural factors are influential and interwoven in the dynamics, negotiations, and tensions of everyday life for people with diabetes. The impact of network on self-management of diabetes needs to be recognized and emphasized in clinical practice, as well as in the education of healthcare professionals, in research as well as in health policy to

understand and respond to provide support and advice to the diabetic patients.

ally lead to autoimmunity and diabetes, especially in children.

guide the proper maturation of the immune system [32].

equipped" to metabolize those substrates [31].

**7. Conclusions**

incidence, and risk reduction.
