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Randomized controlled trials and outcome studies of medical nutrition therapy (MNT) in the treatment of type-1 and type-2 diabetes have reported improved HbAlc levels of approximately 1-2% units (a 15-22% decrease); however, low GI diets compared to high GI diets have only been shown to lower HbAlc by ~0.4% (7% decrease) [29]. MNT in these studies is provided by dietitians/nutritionists as MNT only or as MNT in combination with diabetes self-management training [39]. Interventions for type-2 diabetes include reduced energy intake, reduced fat/carbohydrate intake, carbohydrate counting and basic nutrition and healthy food choices for improved glycemia. Interventions for type-1 diabetes include carbohydrate counting and matching insulin doses to planned carbohydrate intake. Outcomes of the intervention are known by 3 months. Table 4 summarizes randomized controlled trials and outcome studies of MNT in type-1 and type-2 diabetes. Therefore it has been recommended that interventions demonstrated to have the greatest effect on overall glycemic control be implemented first [53]. Individuals with diabetes who can understand and benefit from the concept of low GI foods may be able to use pre- and post-meal blood glucose monitoring to fine tune their food choices.

Until research demonstrates long-term benefits for people with diabetes in the use of the GI, making food choices should be kept as easy and simple as possible. Understanding what foods are carbohydrates, knowing portion sizes, and knowing how many servings to select for meals, and, if desired, for snacks, will benefit the majority of the people with diabetes and can increase variety and flexibility in food choices.

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