Dietary management of patients with type 2 diabetes and chronic kidney disease: A comprehensive literature review

Abstract

Comorbid type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) pose significant global health challenges, particularly in the Middle East and North Africa region. This review synthesizes current evidence and clinical guidelines to inform dietary management, focusing on macronutrients (carbohydrates, protein, fats), micronutrients (potassium, phosphorus, sodium), and fluid intake. We evaluate culturally adapted strategies for the gulf cooperation council countries, where high rates of T2DM and CKD coincide with dietary practices high in refined carbohydrates and sodium. Key interventions include plant-based protein prioritization, glycemic control through carbohydrate moderation, and heart-healthy fats. Practical considerations for Ramadan fasting and electrolyte management are also discussed.

Keywords: Medical nutrition therapy; Diabetes; Chronic kidney disease; Middle East and North Africa region; Cultural adaptation

Core Tip: Effective management of type 2 diabetes and chronic kidney disease (CKD) in the Middle East and North Africa region requires culturally sensitive, evidence-based strategies. Protein intake should be tailored to 0.8–1.3 g/kg/day, emphasizing plant-based sources like legumes and soy to reduce kidney stress. Glycemic control focuses on reducing refined carbohydrates, choosing low-glycemic, high-fiber foods, and sequencing meals with carbohydrates consumed last. Heart-healthy fats such as olive oil, nuts, and fatty fish should replace saturated and trans fats to lower cardiovascular risk. Electrolyte and fluid management includes limiting sodium to less than 2 g per day, restricting potassium and phosphorus from processed sources, and adjusting fluid intake based on CKD stage. Cultural adaptations are key, allowing for traditional foods like hummus and whole grains within Mediterranean or dietary approach to stop hypertension diet patterns. During Ramadan, care plans should be personalized with attention to hydration and medication adjustments to ensure safe fasting practices.