Palabras clave
Nutrición
Terapia médica nutricional
Suplementos dietéticos
Consenso
Patrones dietéticos
Cómo citar
Resumen
Contexto: la terapia médica nutricional (TMN) es una intervención fundamental para el manejo de la diabetes tipo 2. Sin embargo, a pesar de las guías clínicas existentes, la evidencia sólida que respalde las recomendaciones en muchos temas sigue siendo limitada.
Objetivo: el objetivo de este trabajo es desarrollar un consenso de expertos que proporcione orientación clínicamente relevante mediante la integración de la experiencia profesional con una interpretación sistemática de la evidencia disponible. Este enfoque busca garantizar que las decisiones sean informadas, equilibradas y fundamentadas en la mejor comprensión posible de la investigación actual y la experiencia práctica.
Métodos: el proceso de consenso siguió un enfoque estructurado en tres etapas. Primero, se llevó a cabo un grupo focal para identificar los temas clave que requieren atención. Luego, se formularon preguntas utilizando el modelo PICO y se revisó sistemáticamente la evidencia para abordarlas. Finalmente, se aplicó la Técnica de Grupo Nominal para lograr consenso entre los miembros del panel. Se utilizó un análisis combinado cuantitativo y cualitativo para formular las declaraciones finales de consenso.
Resultados: se analizaron y discutieron rigurosamente seis temas principales relacionados con la terapia médica nutricional en la diabetes tipo 2. Una revisión sistemática de 256 artículos revisados por pares respaldó la experiencia del panel multidisciplinario. El panel generó 127 ideas sobre los seis temas, logrando consenso en 78 de ellas. Estas declaraciones de consenso ofrecen definiciones claras y recomendaciones prácticas para implementar la terapia médica nutricional en la práctica clínica.
Conclusiones: este consenso representa un primer paso significativo para abordar un aspecto común pero a menudo pasado por alto del tratamiento de la diabetes tipo 2 en Colombia: la terapia médica nutricional. Al integrar la experiencia multidisciplinaria y el análisis basado en evidencia, se ofrecen recomendaciones accionables y clínicamente significativas para mejorar la atención al paciente.
Citas
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119
Vargas-Uricoechea H, Casas-Figueroa LÁ. An Epidemiologic Analysis of Diabetes in Colombia. Ann Glob Health. 2015;81(6):742-53. https://doi.org/10.1016/j.aogh.2015.11.001
Escobedo J, Buitron LV, Velasco MF, Ramirez JC, Hernandez R, Macchia A, et al. High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study. Diabet Med. 2009;26(9):864-71. https://doi.org/10.1111/j.1464-5491.2009.02795.x
Arteaga JM, Latorre-Santos C, Ibáñez-Pinilla M, Ballesteros-Cabrera MDP, Barón LY, Velosa SA, et al. Prevalence of Type 2 Diabetes, Overweight, Obesity, and Metabolic Syndrome in Adults in Bogotá, Colombia, 2022-2023: A Cross?Sectional Population Survey. Ann Glob Health. 2024;90(1):67. https://doi.org/10.5334/aogh.4539
Fowler LA, Fernández JR, O'Neil PM, Parcha V, Arora P, Shetty NS, et al. Genetic Risk Phenotypes for Type 2 Diabetes Differ with Ancestry in US Adults with Diabetes and Overweight/Obesity. Arch Med Res. 2024;56(3):103128. https://doi.org/10.1016/j.arcmed.2024.103128
Møller G, Andersen HK, Snorgaard O. A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes. Am J Clin Nutr. 2017;106(6):1394-400. https://doi.org/10.3945/ajcn.116.139626
Simões Corrêa Galendi J, Leite R, Banzato LR, Nunes-Nogueira VDS. Effectiveness of Strategies for Nutritional Therapy for Patients with Type 2 Diabetes and/or Hypertension in Primary Care: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(7):4243. https://doi.org/10.3390/ijerph19074243
Brown AW, Aslibekyan S, Bier D, Ferreira da Silva R, Hoover A, Klurfeld DM, et al. Toward more rigorous and informative nutritional epidemiology: The rational space between dismissal and defense of the status quo. Crit Rev Food Sci Nutr. 2023;63(18):3150-67. https://doi.org/10.1080/10408398.2021.1985427
Ioannidis JPA. The Challenge of Reforming Nutritional Epidemiologic Research. J Am Med Assoc. 2018;320(10):969-70. https://doi.org/10.1001/jama.2018.11025
Jackson A, Hettinga DM, Mead J, Mercer C. Using consensus methods in developing clinical guidelines for exercise in managing persistent low back pain. Physiotherapy. 2009;95(4):302-11. https://doi.org/10.1016/j.physio.2009.08.001
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4
Whiting P, Savovi? J, Higgins JP, Caldwell DM, Reeves BC, Shea B, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225-34. https://doi.org/10.1016/j.jclinepi.2015.06.005
Sterne JAC, Savovi? J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
Sterne JA, Hernán MA, Reeves BC, Savovi? J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
McMillan SS, Kelly F, Sav A, Kendall E, King MA, Whitty JA, et al. Using the Nominal Group Technique: how to analyse across multiple groups. Health Serv Outcomes Res Methodol. 2014;14(3):92-108. https://doi.org/10.1007/s10742-014-0121-1
Varga-Atkins T, Bunyan N, Fewtrell R, McIsaac J. The Nominal Group Technique - a practical guide for facilitators. Liverpool: University of Liverpool; 2011.
Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2(3):1-88. https://doi.org/10.3310/hta2030
American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes care. 2024;47(Suppl 1):S77-s110. https://doi.org/10.2337/dc24-S005
López D, Posada C, Roldán P, Earthman CP, Savino P. Educación en nutrición clínica en Colombia. Estado actual y el papel de la educación en línea. Medicina. 2021;43(3):367-81. https://doi.org/10.56050/01205498.1621
Hu M, Zhou Z, Zeng F, Sun Z. Effects of frequency of follow-up on quality of life of type 2 diabetes patients on oral hypoglycemics. Diabetes Technol Ther. 2012;14(9):777-82. https://doi.org/10.1089/dia.2012.0037
Borgundvaag E, Mak J, Kramer CK. Metabolic Impact of Intermittent Fasting in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Interventional Studies. J Clin Endocrinol Metab. 2021;106(3):902-11. https://doi.org/10.1210/clinem/dgaa926
American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025. Diabetes care. 2025;48(Suppl 1):S86-s127. https://doi.org/10.2337/dc25-S005
Jing T, Zhang S, Bai M, Chen Z, Gao S, Li S, et al. Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients. 2023;15(14):3156. https://doi.org/10.3390/nu15143156
Campbell TM, Campbell EK, Attia J, Ventura K, Mathews T, Chhabra KH, et al. The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type 2 diabetes. Diabetes Res Clin Pract. 2023;202:110814. https://doi.org/10.1016/j.diabres.2023.110814
Flanagan A, Bechtold DA, Pot GK, Johnston JD. Chrono-nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns. J Neurochem. 2021;157(1):53-72. https://doi.org/10.1111/jnc.15246
Ferguson BK, Wilson PB. Ordered Eating and Its Effects on Various Postprandial Health Markers: A Systematic Review. J Am Nutr Assoc. 2023;42(8):746-57. https://doi.org/10.1080/27697061.2022.2161664
Hawley JA, Sassone-Corsi P, Zierath JR. Chrono-nutrition for the prevention and treatment of obesity and type 2 diabetes: from mice to men. Diabetologia. 2020;63(11):2253-9. https://doi.org/10.1007/s00125-020-05238-w
Chong GY, Kaur S, Ruzita AT, Wilfred Mok KH, Tan HY, Loy SL, et al. Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population. Chronobiol Int. 2024;41(6):904-23. https://doi.org/10.1080/07420528.2024.2360742
Luján-Barroso L, Margara-Escudero HJ, Crous-Bou M, Huerta JM, Chirlaque MD, Molina-Montes E, et al. Chrono-Nutrition, Chrono-Type, and the Prevalence of Type 2 Diabetes Mellitus in a Cross-Sectional Study from the EuroPean Prospective Investigation into Cancer and Nutrition (EPIC) Study. Nutrients. 2024;16(16):2598. https://doi.org/10.3390/nu16162598
Gómez-Ruiz RP, Cabello-Hernández AI, Gómez-Pérez FJ, Gómez-Sámano M. Meal frequency strategies for the management of type 2 diabetes subjects: A systematic review. PLoS One. 2024;19(2):e0298531. https://doi.org/10.1371/journal.pone.0298531
Santos HO, Genario R, Tinsley GM, Ribeiro P, Carteri RB, Coelho-Ravagnani CF, et al. A scoping review of intermittent fasting, chronobiology, and metabolism. Am J Clin Nutr. 2022;115(4):991-1004. https://doi.org/10.1093/ajcn/nqab433
Mentzelou M, Papadopoulou SK, Psara E, Voulgaridou G, Pavlidou E, Androutsos O, et al. Chrononutrition in the Prevention and Management of Metabolic Disorders: A Literature Review. Nutrients. 2024;16(5):722. https://doi.org/10.3390/nu16050722
American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes care. 2024;47(Suppl 1):S158-s78. https://doi.org/10.2337/dc24-S009
Samson SL, Vellanki P, Blonde L, Christofides EA, Galindo RJ, Hirsch IB, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocr Pract. 2023;29(5):305-40. https://doi.org/10.1016/j.eprac.2023.02.001
Wiebe N, Padwal R, Field C, Marks S, Jacobs R, Tonelli M. A systematic review on the effect of sweeteners on glycemic response and clinically relevant outcomes. BMC Med. 2011;9:123. https://doi.org/10.1186/1741-7015-9-123
Kossiva L, Kakleas K, Christodouli F, Soldatou A, Karanasios S, Karavanaki K. Chronic Use of Artificial Sweeteners: Pros and Cons. Nutrients. 2024;16(18):3162. https://doi.org/10.3390/nu16183162
Khan TA, Lee JJ, Ayoub-Charette S, Noronha JC, McGlynn N, Chiavaroli L, et al. WHO guideline on the use of non-sugar sweeteners: a need for reconsideration. Eur J Clin Nutr. 2023;77(11):1009-13. https://doi.org/10.1038/s41430-023-01314-7
Iizuka K. Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners. Nutrients. 2022;14(21):4446. https://doi.org/10.3390/nu14214446
Dwyer JT, Melanson KJ, Sriprachy-anunt U, Cross P, Wilson M. Dietary Treatment of Obesity. Endotext. MDText.com, Inc; 2015.
Cowan AE, Jun S, Gahche JJ, Tooze JA, Dwyer JT, Eicher-Miller HA, et al. Dietary Supplement Use Differs by Socioeconomic and Health-Related Characteristics among U.S. Adults, NHANES 2011–2014. Nutrients. 2018;10(8):1114. https://doi.org/10.3390/nu10081114
Xia J, Yu J, Xu H, Zhou Y, Li H, Yin S, et al. Comparative effects of vitamin and mineral supplements in the management of type 2 diabetes in primary care: A systematic review and network meta-analysis of randomized controlled trials. Pharmacol Res. 2023;188:106647. https://doi.org/10.1016/j.phrs.2023.106647
Mechanick JI, Marchetti A, Hegazi R, Hamdy O. Diabetes-Specific Nutrition Formulas in the Management of Patients with Diabetes and Cardiometabolic Risk. Nutrients. 2020;12(12):3616. https://doi.org/10.3390/nu12123616
Noronha JC, Mechanick JI. Is There a Role for Diabetes-Specific Nutrition Formulas as Meal Replacements in Type 2 Diabetes? Front Endocrinol. 2022;13:874968. https://doi.org/10.3389/fendo.2022.874968
Lansink M, van Laere KM, Vendrig L, Rutten GE. Lower postprandial glucose responses at baseline and after 4 weeks use of a diabetes-specific formula in diabetes type 2 patients. Diabetes Res Clin Pract. 2011;93(3):421-9. https://doi.org/10.1016/j.diabres.2011.05.019
Angarita Dávila L, Bermúdez V, Aparicio D, Céspedes V, Escobar MC, Durán-Agüero S, et al. Effect of Oral Nutritional Supplements with Sucromalt and Isomaltulose versus Standard Formula on Glycaemic Index, Entero-Insular Axis Peptides and Subjective Appetite in Patients with Type 2 Diabetes: A Randomised Cross-Over Study. Nutrients. 2019;11(7):1477. https://doi.org/10.3390/nu11071477
Chee WSS, Gilcharan Singh HK, Hamdy O, Mechanick JI, Lee VKM, Barua A, et al. Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care. 2017;5(1):e000384. https://doi.org/10.1136/bmjdrc-2016-000384
Wadden TA, Bantle JP, Blackburn GL, Bolin P, Brancati FL, Bray GA, et al. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity. 2014;22(1):5-13. https://doi.org/10.1002/oby.20662
Gilcharan Singh HK, Chee WSS, Hamdy O, Mechanick JI, Lee VKM, Barua A, et al. Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial. PLoS One. 2020;15(11):e0242487. https://doi.org/10.1371/journal.pone.0242487
Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, et al. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes care. 2020;43(7):1636-49. https://doi.org/10.2337/dci20-0023
Quiroga-Padilla PJ, Gaete PV, Nieves-Barreto LD, Montaño A, Betancourt EC, Mendivil CO. Social inequalities shape diet composition among urban Colombians: The Colombian Nutritional Profiles cross-sectional study. Public Health Nutr. 2021;25(10):1-30. https://doi.org/10.1017/S1368980021004778
Mendivil CO, Gutiérrez Romero SA, Peláez-Jaramillo MJ, Nieves-Barreto LD, Montaño-Rodríguez A, Betancourt-Villamizar E. Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)—a cross-sectional study. BMJ Open. 2021;11(6):e042050. https://doi.org/10.1136/bmjopen-2020-042050
Martínez-González MA, Salas-Salvadó J, Estruch R, Corella D, Fitó M, Ros E. Benefits of the Mediterranean Diet: Insights From the PREDIMED Study. Prog Cardiovasc Dis. 2015;58(1):50-60. https://doi.org/10.1016/j.pcad.2015.04.003
Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. World J Diabetes. 2021;12(12):2036-49. https://doi.org/10.4239/wjd.v12.i12.2036
Rojas Henao NA, Garcia-Rivera M, Hernandez AC, Díaz Giraldo J, Builes-Montaño CE. Direct costs of severe hypoglycemia events in individuals with diabetes mellitus: a perspective from the Colombian health system - a single-center study. Hosp Pract. 2025;53(1):2439775. https://doi.org/10.1080/21548331.2024.2439775
Gutiérrez-Romero SA, Pérez-Londoño A, Cuéllar-Rodríguez V, Correa-Osio I, Betancourt-Villamizar C, Mendivil CO. Diabetes and Socioeconomic Position in Urban Colombia: A Cross-Sectional Study of its Prevalence, Lifestyle Habits, and Sources of Health Information. The Lancet. 2024.
Zhang R, Noronha JC, Khan TA, McGlynn N, Back S, Grant SM, et al. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis. Nutrients. 2023;15(4):1050. https://doi.org/10.3390/nu15041050
Nichol AD, Holle MJ, An R. Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2018;72(6):796-804. https://doi.org/10.1038/s41430-018-0170-6
Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2020;112(4):1002-14. https://doi.org/10.1093/ajcn/nqaa167
Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023;29(3):710-8. https://doi.org/10.1038/s41591-023-02223-9
Khafagy R, Paterson AD, Dash S. Erythritol as a Potential Causal Contributor to Cardiometabolic Disease: A Mendelian Randomization Study. Diabetes. 2024;73(2):325-31. https://doi.org/10.2337/db23-0330
Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, et al. Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med. 2022;19(3):e1003950. https://doi.org/10.1371/journal.pmed.1003950
Pavanello S, Moretto A, La Vecchia C, Alicandro G. Non-sugar sweeteners and cancer: Toxicological and epidemiological evidence. Regul Toxicol Pharmacol. 2023;139:105369. https://doi.org/10.1016/j.yrtph.2023.105369
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Derechos de autor 2025 Revista Colombiana de Endocrinología, Diabetes & Metabolismo