title: [Carbohydrate: current role in diabetes mellitus and metabolic disease].
abstract: BACKGROUND
  There is a prevalence of diabetes mellitus (DM), unknown DM and stress hyperglycemia among hospital patients, and the nutritional treatment is a key part of care, where carbohydrates (CH) intake is a controversial issue. There is also a discussion on the increase of prevalence for DM, obesity and metabolic disease with refined CH or sugar.
  
  
  OBJECTIVE
  This review examines the recommendations from different scientific societies about the percentage of CH in the total calorie intake of the diabetic patient, the CH value in the glycemic index and glycemic load, the new CH included in enteral formulae and the association of refined CH with the high prevalence of DM and metabolic disease.
  
  
  METHODS
  Systematic review of literature using the electronic scientific databases Pubmed, Science Direct, Scielo, Scopus and Medline.
  
  
  CONCLUSIONS
  Scientific societies are flexible about the CH intake in the diet of diabetic patients, suggesting to customize it according to each metabolic profile. Using the glycemic index and glycemic load can provide an extra benefit in the postprandial glycemic control. The new diabetes-specific enteral formulae, with fructooligosaccharides, resistant maltodextrins and fructose-free show efficacy in improving the glycemic control, although more controlled and long-term studies are needed. There is still some controversy about the links between sugar intake and DM, obesity and metabolic disease, although this relationship would be more linked to an increase of the total calorie intake than to a specific nutrient.
authors.affiliation: Unidad de Nutrición Clínica y Dietética. UGC de Endocrinología y Nutrición. Hospital Virgen de las Nieves. Granada.. vlunal@yahoo.es.
authors.forename: Victoria
authors.initials: V
authors.lastname: Luna López
authors.affiliation: UGC de Endocrinología y Nutrición. Hospital Universitario Virgen de la Victoria. Málaga.. jalmedi@hotmail.com.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: López Medina
authors.affiliation: UGC de Endocrinología, Nutrición y Riesgo Vascular. Hospital Torrecárdenas. Almería.. MMERVG@GMAIL.COM.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Vázquez Gutiérrez
authors.affiliation: Unidad de Nutrición Clínica y Dietética. UGC de Endocrinología y Nutrición. Hospital Universitario San Cecilio. Granada. España.. marisafsoto@gmail.com.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Fernández Soto
mesh_terms: D003920:Diabetes Mellitus / Q000209:etiology*; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D002149:Energy Intake; D006801:Humans; D008659:Metabolic Diseases / Q000209:etiology*; D009751:Nutritional Requirements; D009765:Obesity / Q000209:etiology
chemical_list: D004040:Dietary Carbohydrates