1. Type-2 Diabetes Mellitus (T2DM) is the most commonly diagnosed form of diabetes,1
accounting for 90-95% of patients diagnosed. The leading factor for the development of T2DM
is being overweight or obese, BMI ≥25 or ≥30 respectively.3
There are many other causes of
T2DM such as family history, physical inactivity, poor diet, the older aged population, or certain
population groups such as African Americans, Hispanic Americans, Native Americans, and
Asian Americans/Pacific Islanders.5-6
Currently, there are about 350 million people worldwide
diagnosed with T2DM.7
In 2012, 79 million people were estimated to have pre-diabetes, a
condition in which patients exhibit impaired glucose tolerance (IGT) and impaired fasting
glycemia (IFG)8,
in America.9-11
Medical nutrition therapy (MNT) has been one of the main
approaches for lifestyle modification in the management of diabetes.7,14
The main goal for MNT
for patients with diabetes is lowering of blood glucose levels.14
Some approaches to lowering
blood glucose levels include diets rich in whole grains or low in glycemic index levels diets. 1,6-
8,14-17
Research shows an inverse association exists with the consumption whole grains and risk
of diabetes. However, many of the studies providing evidence had multiple limitations such as a
small sample size, short time frame, or use of subjective data that could lead to the under/over
reporting of certain food groups. These studies also didn’t have statistically significant data that
supported that whole grain consumption had any benefits in improving FPG or HbA1C levels.
There is strong evidence to support whole grain diets may reduce the risk of developing T2DM
and should be increased for those who are at higher risk or have prediabetes.1,6,8,14-16
Low
glycemic index diets have shown a greater reduction in blood glucose levels compared to high
fiber diets.18-19
as well as a greater weight loss.19
In conclusion, low glycemic index diets can be
used in reducing blood glucose levels in patients with T2D as compared to whole grain diets.

2. References
1. Ye EQ, Chacko SA, Chou EL, Kugizaki M, Liu S. Greater Whole-Grain Intake is
Associated with Lower Risk of Type 2 Diabetes, Cardiovascular Disease, and Weight
Gain. Journal of Nutrition 2012 May;1304-13.
2. American Diabetes Association. Facts about Type 2 [report on the Internet]. Alexandria
(VA): ADA; 2013 [cited 2013 Oct 23];. Available from:
http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html
3. A. (n.d.). Advocate. Prevention. Retrieved October 10, 2013, from
http://www.diabetes.org/advocate/our-priorities/prevention/
4. N. (2012, January). Prevalence of Obesity in the United States, 2009-2010. Centers for
Disease Control and Treatment. Retrieved October 10, 2013, from
http://www.cdc.gov/nchs/data/databriefs/db82.pdf
5. Medline Plus. The National Library of Medicine [Internet]. Bethesda (MD). Type 2
Diabetes; 2013 [cited 2013 Oct 17]; [about 3 screens]. Available from:
http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm
6. Montonen J, Knekt P, Jarvinen R, Aromaa A, Reunanen A. Whole-grain and fiber intake
and the incidence of type 2 diabetes. Am J Clin Nutr 2003 Jan;77:622-9.
7. Christensen AS, Viggers L, Hasselstrom K, Gregerson S. Effect of restriction on
glycemic control in patients with type 2 diabetes-a randomized trial. Nutrition Journal
2013;12(29):1-6.
8. Wirstrom T, Hilding A, Gu HF, Ostenson CG, Bjorklund A. Consumption of whole grain
reduces risk of deteriorating glucose tolerance, including progression to prediabetes. Am
J Clin Nutr 2013 Jan;97(1):179-87.

3. 9. C. (2013). H.R.1257 - Preventing Diabetes in Medicare Act of 2013. Congress. Retrieved
October 10, 2013, from http://beta.congress.gov/bill/113th/house-bill/1257/text
10. A. (2013, September). The Preventing Diabetes in Medicare Act (H.R. 1257). Academy
of Nutrition and Dietetics. Retrieved October 10, 2013, from http://www.eatright.org/
Members/legislation/
11. C. (2011). National Diabetes Fact Sheet: National Estimates and General Information on
Diabetes and Prediabetes in the United States, 2011. Centers for Disease Control and
Treatment. Retrieved October 10, 2013, from http://www.cdc.gov/diabetes/pubs/
pdf/ndfs_2011.pdf
12. A. (n.d.). Diabetes by the Numbers: Stop Diabetes® American Diabetes Association.
Stop Diabetes. Retrieved October 10, 2013, from http://www.stopdiabetes.com/get-the-
facts/diabetes-by-the-numbers.html
13. C. (2011). National Health Expenditure Data. Centers for Medicare & Medicaid Services.
Retrieved October 10, 2013, from http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html
14. Post RE, Mainous AG, King DE, Simpson KN. Dietary Fiber for the Treatment of Type 2
Diabetes Mellitus: A Meta-Analysis. J Am Board Fam Med 2012;25:16-23.
15. Youn M, Csallany AS, Gallaher DD. Whole grain consumption has a modest effect on
the development of diabetes in the goto-kakisaki rat. Br J Nutr 2012 Jan;107(2):192-201.
16. Kim TH, Kim EK, Lee MS, Lee HK, Hwang WS, Choe SJ, Kim TY, Han SJ, Kim HJ,
Kim DJ, et al. Intake of brown rice lees reduces waist circumference and improves
metabolic parameters in type 2 diabetes. Nutr Res 2011 Feb;31(2):131-8.

4. 17. Bajorek SA, Morello CM. Effects of Dietary Fiber and Low Glycemic Index Diet on
Glucose Control in Subjects with Type 2 Diabetes Mellitus. The Annals of
Pharmaeotheraoy 2010 Nov;44:1786-92.
18. Riccardi G, Rivellese AA, Giacco R. Role of glycemic index and glycemic load in the
healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008;87(suppl):269s-74s.
19. Jenkins DJA, Kendall CWC, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL,
Vidgen E, Josse AR, Ngyuen TH, Corrigan S, Banach MS, Ares S, Mitchell S, Emam A,
Augustin LSA, Parker TL, Leiter LA. Effect of a Low-Glycemic Index or High-Cereal
Fiber Diet on Type 2 Diabetes: A Randomized Trial. JAMA 2008;300(23):2742-53.