The NICE guidance (NICE, 2022) keeps advice broad and generalised for patients.

The broad advice includes “being active, losing weight if you are overweight, getting enough exercise, heaving a healthy diet, not smoking and controlling your alcohol intake if you drink alcohol”

It then places the onus on medical professionals to give further specific advice, “your doctor or nurse should give you more information about a healthy lifestyle and what you can do to help keep your type 2 diabetes under control (for example, having a healthy diet, taking more exercise and losing weight)”.

It states “an expert such as a dietitian should give you advice about your diet. This should be designed to suit your lifestyle, culture, beliefs or preferences”. There is a difficulty with this approach as it places the onus on health professionals, and thus makes the assumption that we should know the right methods to help lead to diabetic remission and weight loss, despite the guidance remaining vague.

Other specific advice now includes “eat low-fat dairy products and oily fish, limit the amount of food that you eat that contains saturated fats and trans fatty acids”.

It also recommends “there is no need to buy food sold specifically for people with diabetes because this tends to be expensive and is not necessarily any better for you”. This advice is particularly broad.

It gives further recommendations on what questions patients should ask to health professionals including:

• Please explain more about how what I eat and drink affects my diabetes
• What sorts of foods should I eat?
• Do I have to avoid sugary foods?
• Can I eat carbohydrates?
• What are the effects of alcohol on my diabetes?
• How will losing weight help?
• What sorts of exercise are best? Are there any types of exercise I shouldn't do?
• Where can I get advice and support about giving up smoking?
• Are there any support groups in my local area?
• What could happen if I do not change my lifestyle?
• What information and support is available to help me make changes to my lifestyle?

NICE guidance for health professionals

Nice guidance (National Institute for Clinical Excellence, 2022) includes:

1.3.1 - Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition.
1.3.2 - Provide dietary advice in a form sensitive to the person's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life
1.3.3 - Encourage adults with type 2 diabetes to follow the same healthy eating advice as the general population, which includes: eating high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, wholegrains and pulses
choosing low-fat dairy products eating oily fish controlling their intake of saturated and trans fatty acids
1.3.4 - Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification such as increasing physical activity and losing weight
1.3.6 - Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Make reducing the risk of hypoglycaemia a particular aim for people using insulin or an insulin secretagogue
1.3.7 - Advise adults with type 2 diabetes that they can substitute a limited amount of sucrose-containing foods for other carbohydrate in the meal plan but should take care to avoid excess energy intake
1.3.8 - Discourage adults with type 2 diabetes from using foods marketed specifically for people with diabetes
1.3.9 - When adults with type 2 diabetes are admitted as inpatients to hospital or any other care setting, implement a meal planning system that provides consistency in the carbohydrate content of meals and snacks