# Effectiveness of a Nutrition Education Program for Patients with Type 2 Diabetes Mellitus
## 4 Discussion
The dietitian in all the studies followed some strategies for weight loss (>1 kg/month) such as dietary plans with detailed diet information or advice on cooking and minimizing the frequency of eating out and some other support tools like a food exchange list. Some specifically list replacement foods organized by food groups and guidelines on healthy food choices or even healthy recipes [58]. After the nutritional intervention, a change was observed in all biochemical indices and anthropometric characteristics studied. Therefore, the adoption of a careful dietary pattern based on the Mediterranean diet can lead to significant and long-term changes in metabolic profile due to minimizing ultra-processed foods, which are high in saturated fats and added sugars. Such changes protect against cardiovascular complications [59; 60]. Diet advice via individual sessions as treatment has occurred in many studies [61]. A single dietary counseling session [62], as in our study and others, did not have the same results as can occur in more intensified interventions such as weekly [63], fortnightly [64] or monthly sessions [20]. Dietary patterns such as the Mediterranean diet as well as physical activity are crucial for improving the metabolic disturbances seen in patients with diabetes [65]. The primary goal is to reduce saturated and trans fatty acids. Dietary plans documented to reduce body weight at least by 5% in overweight and obese people should also reduce total fat to <30% of daily energy intake, reduce saturated fat (including trans fatty acids) to <10% of daily energy intake, increase fiber intake (14g/1000 Kcal) [66], minimize refined and processed foods [67] and increase omega-3 fatty acid intake [68]. Increasing the daily consumption of natural foods rich in dietary antioxidants (tocopherols, carotenoids, vitamin C, flavonoids, polyphenols), trace elements and vitamins by increasing vegetable and fruit intake to 400 g/day should be encouraged [69]. Educational meetings with the dietitian in primary care will possibly help patients better understand type 2 diabetes and show how they can control it with easy-to-apply lifestyle changes. The interaction and exchanges between different specialists, a friendly atmosphere of meetings, weight loss tips, including the latest research-backed strategies, healthy eating plans, smart nutritional secrets, meal-planning help and lifestyle strategies to help manage diabetes could help patients control diabetes. Moreover, effective social support with assistance and encouragement from family members, adequate self-management skills and self-efficacy (confidence) may reduce the risk of developing diabetes complications [70]. In our study, despite recommendations from health professionals to adopt a healthier lifestyle, many patients avoided exercising, while a high percentage of patients smoked. These practices are anything but helpful in controlling the disease. This finding should concern and activate health professionals to mobilize change in the behavior and habits of patients. Exercise seems to have a positive association not only with the regulation of systolic and diastolic blood pressure [71] but also with glycemic control [72] and variability, insulin sensitivity, lipid profile, oxidative stress/antioxidative capacity and/or chronic inflammation [73]. Although there is limited evidence, stopping smoking has been shown to have benefits in reducing or slowing the risk of cardiovascular morbidity and mortality in people with diabetes [74]. The nutritional intervention adopted by our patients was based on the principles of the Mediterranean diet [69]. The Mediterranean diet is considered to be a model of healthy eating. Its beneficial actions are generally accepted both in the general population and in patients with T2 DM [66]. It is a food pattern that satisfies all the conditions of a suitable diet for the regulation of the disease. It is therefore necessary to inform patients about the beneficial effects of this nutritional model in order to adopt it in their daily lives.