From the Guidelines
Implications of Hyperglycemia and Proteinuria
Hyperglycemia and proteinuria have significant implications for patients with diabetes, including increased risk of nephropathy and accelerated progression of kidney disease.
- Hyperglycemia can contribute to an increased turnover of protein, suggesting an increased need for protein in patients with diabetes 1.
- Proteinuria is a marker of kidney damage and is associated with an increased risk of cardiovascular disease and mortality.
Protein Intake and Nephropathy
- A high-protein intake (>20% of total daily energy) may have a detrimental effect on renal function, particularly in patients with macroalbuminuria 1.
- However, intake of protein in the usual range (15-20% of total daily energy) does not appear to be associated with the development of diabetic nephropathy 1.
Protein Requirements
- Patients with diabetes may have an increased need for protein, particularly during weight loss, due to moderate hyperglycemia and an altered adaptive mechanism for protein sparing 1.
- The protein requirements of people with diabetes may be greater than the recommended dietary allowance (RDA) of 0.8 g protein/kg body weight, although not greater than usual intake, which is 1.0 g protein/kg body weight or 100 g protein/day 1.
From the Research
Implications of Hyperglycemia
- Hyperglycemia is associated with an increased risk of cardiovascular disease, as it leads to the glycation of lipoproteins, which reduces their uptake and catabolism via the classical low-density lipoprotein (LDL) receptor 2
- Hyperglycemia also increases the formation of oxidized LDL and glycated LDL, which are important modulators of atherosclerosis and cardiovascular death 2
- Even short-term derangement of blood sugar control can increase the risk of cardiovascular death, owing to the glycation of lipoproteins and other critical proteins 2
Implications of Proteinuria
- There is no direct evidence in the provided studies that discusses the implications of proteinuria
Relationship between Hyperglycemia and Protein Intake
- High protein intake can have both positive and negative effects on glucose metabolism, with some studies suggesting that it can improve glycemic control in type 2 diabetic patients, while others suggest that it may increase the risk of developing type 2 diabetes 3, 4, 5
- A high protein diet can stimulate insulin secretion and improve glucose-stimulated insulin secretion, but it can also increase endogenous glucose output and reduce glucose disposal 5
- The optimal macronutrient composition for the treatment and prevention of obesity and type 2 diabetes is not known, due to the lack of well-controlled long-term studies 3
Effects of Dietary Fat and Protein on Glucoregulatory Hormones
- Dietary fat and protein can impact postprandial hyperglycemia in people with type 1 diabetes, and may contribute to this effect through the modulation of glucoregulatory hormones such as GLP-1, GIP, and glucagon 6
- Meals low in fat and protein have minimal effect on GLP-1, while high protein meals can sustain elevation of GLP-1 and GIP, and increase glucagon secretion 6