**2. Dietary and behavioral changes**

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.

its roots in southern European eating patterns. The typical Mediterranean diet, which was first postulated by Ancel Keys in the 1960s [8], is characterized by high intakes of mono-unsaturated fatty acids, vegetables and fruits, plant proteins, whole grains, fish and low-fat dairy products, moderate alcohol (red wine) intake, and low red meat consumption [9]. Following this dietary consumption has demonstrated a reduced risk of mortality associated with mostly neurodegenerative diseases [9, 10]. According to the systematic review by Schwingshackl et al. [9], it was revealed that a significant association between adherence to dietary patterns exhibiting specific Mediterranean diet characteristics and decreased risk of type 2 diabetes. With respect to potential mechanisms of action, there appears to be a causal link between oxidative stress, inflammation, endothelial dysfunction, and diabetes when following this dietary pattern [11]. The Mediterranean diet has also shown a durable effect on circulating levels of C-reactive protein (CRP) and adiponectin in subjects with newly diagnosed type 2

Introductory Chapter: The Need for Dietary Interventions for Diabetes

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

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diabetes [12]—an aspect, which is directly related to anti-inflammatory activities.

tional diabetes.

**4. Dietary diversity**

An observational study aimed to explore a possible relationship between the incidence of gestational diabetes mellitus and the Mediterranean diet pattern of eating was conducted by Karamanos et al. [13]. In this study, in 10 Mediterranean countries, 1076 consecutive pregnant women underwent a 75-g oral glucose tolerance test (OGTT) at 24–32 weeks of gestation, interpreted both by the American Diabetes Association (ADA) 2010 and the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2012 criteria. Adherence to a Mediterranean dietary pattern of eating was found to be associated with lower incidence of gestational diabetes and better degree of glucose tolerance, even in women without gesta-

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

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 incidence and propagation of the disease.

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

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.
