Dietary carbohydrate intake in patients with type 2 diabetes mellitus and diabetes control: a cross-sectional study

  • Muneera Q Al-Mssallem King Faisal University, Department of Food Sciences and Nutrition, Faculty of Agricultural and Food Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
  • Ali Al-Qarni King Abdullah International Medical Research Centre, Eastern region, Ministry of National Guard Health affairs
  • Mohammed Al-Jamaan Primary Health Care, King Abdullah Military Housing, Ministry of National Guard Health Affairs, Eastern Region, Saudi Arabia
Keywords: Available carbohydrate; Blood glucose; HbA1c; Macronutrients; Type 2 diabetes


Background: Food intake has important implications for patients with type 2 diabetes.

Objective: Similarly, in other crop species, this observational study aimed to assess dietary carbohydrate (CHO) and non-starch polysaccharide (NSP) intake and examine their association with glycemic control among Saudi patients with type 2 diabetes mellitus (T2DM).

Design: We investigated dietary intake in 404 patients (207 males and 197 females) with T2DM between November 2018 and March 2019. Dietary intake was assessed by face-to-face interviews using a validated dietary questionnaire.

Results: The results revealed that dietary CHO intake (67% of energy) exceeded the recommended daily intake, and white rice (Basmati rice) was the major contributor to CHO intake. However, the dietary NSP intake was lower than recommended, and it was negatively associated with HbA1c levels.

Conclusion: This cross-sectional study showed that dietary CHO intake was high among Saudi patients with type 2 diabetes, and that their daily intake of NSPs was correlated with a lower level of HbA1c. Dietary advice should be given for patients with diabetes to reduce their intake of starchy food such as rice.


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  1. Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018; 361: k2234. doi: 10.1136/bmj.k2234

  2. Livesey G, Taylor R, Livesey HF, Buyken AE, Jenkins DJ, Augustin LS, et al. Dietary glycaemic index and load and the risk of type 2 diabetes: a systematic review and updated meta-analyses of prospective cohort studies. Nutrients 2019; 11(6): 1280. doi: 10.3390/nu11061280

  3. Jaacks LM, Siegel KR, Gujral UP, Narayan KM. Type 2 diabetes: a 21st century epidemic. Best Prcact Res Clin Endocrinol Metab 2016; 30(3): 331–43. doi: 10.1016/j.beem.2016.05.003

  4. International Diabetes Federation (IDF). IDF diabetes atlas. 9th ed. IDF; 2019. Available from: [cited 2020 Sep 13]

  5. Meyer KA, Kushi LH, Jacobs DR, Slavin JJ, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 2000; 71: 921–30. doi: 10.1093/ajcn/71.4.921

  6. Wolever TM, Brand-Miller J, Abernethy J, Astrup A, Atkinson F, Axelsen M, et al. Measuring the glycemic index of foods: interlaboratory study. Am J Clin Nutr 2008; 87: 247S–57S.

  7. Zhang G, Hamaker BR. Slowly digestible starch: concept, mechanism, and proposed extended glycemic index. Crit Rev Food Sci Nutr 2009; 49: 852–67. doi: 10.1080/10408390903372466

  8. Brouns F, Bjorck I, Frayn KN, Gibbs AL, Lang V, Slama G, Wolever TMS. Glycaemic index methodology. Nutr Res Rev 2005; 18: 145–71. doi: 10.1079/NRR2005100

  9. Monro J. Redefining the glycemic index for dietary management of postprandial glycemia. J Nutr 2003; 133: 4256–8. doi: 10.1093/jn/133.12.4256

  10. ADA, American Diabetes Association. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2020. Diabetes Care 2020; 43(Suppl.1): S48–65. Available from: [cited 2020 Sep 12]

  11. ADA, American Diabetes Association. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care 2019; 42(Suppl. 1): S46–60. doi: 10.2337/dc19-S005

  12. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 2019; 42(5): 731–54. Available from: [cited 2020 Sep 13]

  13. McRae MP. Dietary fiber intake and type 2 diabetes mellitus: an umbrella review of meta-analyses. J Chiropr Med 2018; 17(1): 44–53. doi: 10.1016/j.jcm.2017.11.002

  14. Englyst KN, Englyst HN. Carbohydrate bioavailability. Br J Nutr 2005; 94: 1–11. doi: 10.1079/BJN20051457

  15. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37(Suppl.1): 120S–43S. doi: 10.2337/dc14-S120

  16. Salmeron J, Ascherio A, Rimm EB, Colditz GA, Spieqelman D, Jenkins DJ, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997; 20: 545–50. doi: 10.2337/diacare.20.4.545

  17. Schulze Mathias B, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in young and middle-aged women. Am Clin Nutr 2004; 80: 348–56. doi: 10.1093/ajcn/80.2.348

  18. Sluijs I, van der Schouw YT, van der AD, Spijkerman AM, Grobbee DE, Beulens JW. Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study. Am J Clin Nutr 2010; 92: 905–11. doi: 10.3945/ajcn.2010.29620

  19. Stevens J, Ahn K, Juhaeri, Houston D, Steffan L, Couper D. Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults. Diabetes Care 2002; 25: 1715–21. doi: 10.2337/diacare.25.10.1715

  20. Robert AA, Al Dawish MA. The worrying trend of diabetes mellitus in Saudi Arabia: an urgent call to action. Curr Diabetes Rev 2020; 16(3): 204–10. doi: 10.2174/1573399815666190531093735

  21. Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al. Diabetes mellitus in Saudi Arabia: a review of the recent literature. Curr Diabetes Rev 2016; 12(4): 359–68. doi: 10.2174/1573399811666150724095130

  22. Gosadi IM, Alatar AA, Otayf MM, AlJahani DM, Ghabbani HM, AlRajban WAet al. Development of a Saudi Food Frequency Questionnaire and testing its reliability and validity. Saudi Med J 2017 Jun;38(6):636–41. doi: 10.15537/smj.2017.6.20055

  23. Musaiger A. Food composition tables for Kingdom of Bahrain. Manama, Bahrain: Arab Center for Nutrition; 2011. Available from: [cited 2020 Sep 17]

  24. ADA, American Diabetes Association. Standards of medical care in diabetes-2020. Diabetes Care 2020; 43(Suppl. 1): S1–S212. Available from: file:///Users/MQM%201/Library/Mobile%20Documents/com~apple~CloudDocs/MQM%20Folder/KFU1st-01-1432H/KFU-Research/Dates%20&%20T2DM%20at%20NGHA1440/Ref/ADA%202020%20.pdf [cited 2020 Sep 17]

  25. Al-Mssallem MQ. The association between the glycaemic index of some traditional Saudi foods and the prevalence of diabetes in Saudi Arabia: a review article. J Diabetes Metab 2014; 5(11): 452. doi: 10.4172/2155-6156.1000452

  26. Al-Mssallem MQ. Consumption of traditional Saudi foods and their estimated glycaemic index and glycaemic load. Pak J Nutr 2018; 17(11): 518–23. doi: 10.3923/pjn.2018.518.523

  27. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, et al. Health benefits of dietary fiber. Nutr Rev 2009; 67: 188–205. doi: 10.1111/j.1753-4887.2009.00189.x

  28. Liese A, Schulz M, Fang F, Wolever T, D’Agostino RJ, Sparks K, et al. Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study. Diabetes Care 2005; 28: 2832–8. doi: 10.2337/diacare.28.12.2832

  29. 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(1): 16–23. doi: 10.3122/jabfm.2012.01.110148

  30. Al-Mssallem MQ, Frost GS, Brown JE. The metabolic effects of two meals with the same glycaemic index but different slowly available glucose parameters determined in vitro: a pilot study. Ann Nutr Disorders Ther 2014; 1(1): 1–5.

  31. Medina-Remón A, Kirwan R, Lamuela-Raventós RM, Estruch R. Dietary patterns and the risk of obesity, type 2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenerative diseases. Crit Rev Food Sci Nutr 2018; 58(2): 262–96. doi: 10.1080/10408398.2016.1158690

How to Cite
Al-Mssallem, M. Q., Al-Qarni, A., & Al-Jamaan, M. (2020). Dietary carbohydrate intake in patients with type 2 diabetes mellitus and diabetes control: a cross-sectional study. Food & Nutrition Research, 64.
Original Articles