Nutritional status and dietary management of elderly diabetic patients.

Dietary treatment of diabetes has long been the cornerstone of management of this common disease. Recent recommendations to increase the proportion of carbohydrate with concomitant reduction of dietary fat appear to be prudent, but scant data are available to support this supposition in the elderly. Modification of the source of carbohydrate as a means of providing better blood glucose control is based on limited data in controlled settings and needs to be tested in community settings before widespread alterations in the dietary composition can be widely recommended. Current recommendations for protein composition of the diet are probably adequate for the elderly diabetic patient who does not have obvious protein depletion. General guidelines for the dietary management of elderly diabetic patients are summarized in Table 5. Management of the elderly diabetic patient presents a strong challenge to the physician. Dietary recommendations for such patients should be highly individualized; patients' food preferences, ethnic background, financial resources, and support system should be taken into consideration. Simple recommendations drafted with the help of the patient are more likely to be successful. The elderly are often at risk for nutritional deficiency, and the presence of chronic disease such as diabetes profoundly affects metabolism, putting these individuals at still higher risk. Unfortunately, our current understanding of this problem is limited and additional research in this area is essential.