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Exchange system
This system is based on the classification of the main food groups: carbohydrates
(starches, fruit, milk, vegetables), meat and fish (proteins) and fat. Food tables are
provided which include the proportion for 100 g of the different active principles.
The food with similar nutrient values are numbered together and these can be
exchanged for any other belonging to the same list. The common portions of each
food are numbered, including its weight in grams. The exchange lists are used to
achieve an appropriate nutrient contribution and provide a variety when planning
the meals.
An SR (82) compared the effectiveness of the exchange diets in contrast to
a standard diet with low fat reduction. No conclusion was established due to the
lack of evidence available.
In an RCT not included in the SR no differences were found between the exchange
diet recommended by the ADA and a weekly planned diet. Both improved
weight loss, glycemic control and the lipid profile (96).
The CPG recommends the mid-night snack to avoid night hypoglycaemia in
patients on pharmacological treatment (79), though no studies have been found
on this issue.
SR of RCT
1+
RCT
1+
Expert
opinion
4
Evidence summary
1+ Dietary changes, exercise and behavioural therapies are effective in DM 2 weight
loss and glycemic control. Their combination increases efficacy (73; 82).
1+ Diets with high amount of fibre and a 55% to 60% of carbohydrates are more efficient
for glycemic control than the diets with moderate amounts of carbohydrates
(30%-54%) and a low or moderate amount of fibre (81).
1+ Diets based on food with low glycemic indexes show a favourable tendency in glycemic
control (81).
1+ Diets where the amount of fat consists of polyunsaturated fatty acids improve the
lipid profile in diabetic patients (91).
1+ Drugs for obesity (orlistat, sibutramine, rimonabant) are effective for weight loss and
improve glycemic control. Nevertheless, the frequent or potentially severe adverse
effects limit their use (83; 87). Sibutramine can provoke adverse effects at cardiovascular
level (83). Rimonabant has been withdrawn form the market.
1+/2+/3 Surgical treatment for DM 2 patients and those with morbid obesity is effective to
reduce weight and to improve the glycemic profile in specific cases (88).
1+ Omega 3 fatty acid supplements reduce triglycerides and produce a slight increase
in LDL levels (92).
2+ Moderate alcohol intake is associated with a reduction of cardiovascular morbimortality
risk without presenting any effect on glycemic control (36; 93).
4 There are several useful systems to plan diets (based on meals, guidelines, carbohydrates
count, exchange). Their effectiveness has not been compared (79).
56 CLINICAL PRACTICE GUIDELINES IN THE NHS