Patients with type 2 diabetes or even prediabetes may be trying to eat healthy, choosing products with various health claims but are nonetheless “sugar traps.”

Such foods can impair glycemic control and exploit the common misconceptions that “natural” sugars are safe and that “sugar-free” means no impact on glycemic control, said Yuval Pinto, MD, assistant professor of medicine and part of the Healthful Eating, Activity & Weight Program at Johns Hopkins School of Medicine in Baltimore.

Why Food Labels Are Not Sufficient

Although food labels provide basic nutritional information, they have several limitations that should be taken into consideration in the glycemic management of patients with diabetes and prediabetes, Pinto said.

Glycemic index: Food labels report total carbohydrates; however, two foods with identical carbohydrate amount could produce a substantially different glycemic response, Pinto said.

Degree of food processing: The degree of food processing affects absorption, and the adverse effects of processed and ultraprocessed foods on health are well established, he said. “Food labels do not provide information about the degree of processing,” Pinto said.

Individual variability: Food labels presume all consumers are healthy and alike. “The numbers and values they include should be taken into consideration alongside other factors, such as gut microbiome effects, levels of physical activity, medications, and comorbidities,” he said.

How Primary Care Providers (PCPs) Can Advise Patients

To personalize the patient care model, Pinto noted recommendations according to disease severity: diabetic vs prediabetic vs nondiabetic. Action items may include:

• Identify and educate about sugar traps.
• Teach smart label reading and explain limitations of food labels.
• Discuss dietary food recommendations.
• Remind patients of avoidance/minimizing hidden sugars.
• Emphasize food order guidelines. “Consuming nonstarchy vegetable and protein before carbohydrates during meals attenuated postprandial glucose spikes,” said Pinto.
• Recommend postmeal workouts. A brief 10-15-minute walk after meals has been shown to significantly reduce postprandial glucose levels, said Pinto. “The timing of exercise, specifically within 30-60 minutes post-meal, is more important than total daily exercise duration for acute glycemic control,” he said.
• Refer patient to a clinical dietician. This clinician can provide comprehensive medical nutrition therapy that includes food preferences, socioeconomic factors, and individualized meal planning, he said.

Explaining Insulin Resistance and Sugar Traps

Most Americans have type 2 diabetes that’s characterized by insulin resistance.

“Insulin resistance can be amplified by excessive sugars and refined carbohydrates by supporting weight gain and post meal blood sugar surges,” said Bethany Doerfler, RD, senior clinical research dietitian at the Digestive Health Institute at Northwestern Medicine in Chicago.

As a PCP, guiding patients to make informed decisions about sugar consumption can be beneficial.

“The sugars naturally occurring in fruits and starchy vegetables behave very differently from added sugars,” she said. “Fruit with cheese is a much better snack than say pretzels and cheese.” Also, she recommends patients keep an eye on sugars and keep added sugars to ~ 6 g per meal. “Again, these are sugars added to foods not those naturally occurring,” said Doerfler.

In addition, she provided these foods that could be sugar traps for your patients.

• Breakfast cereals: Reading labels can shed light on sugar content. It is all about what is hidden in the labels, and the varieties of specific cereals are also important. “Regular Cheerios has 1 g added sugar while the honey nut variety has 13 g of sugar. People can be confused by the brand alone,” said Doerfler.
• Granola bars: There are vast differences in added sugars from 7-22 g. “The key is to not be fooled by whole grains or nuts and be sure to have patients read the labels,” she said.
• Store-bought pastries: It’s always better to make your own, when possible. “Try adding less sugar or pureed fruit over table sugar,” Doerfler said.
• Energy and electrolyte drinks: “Most of us don’t need electrolyte drinks which can provide more than 20 g added sugar. It’s best to drink water after a work-out,” she further said.
• Fruit juices and smoothies: Although touted as including 100% “natural” juice, patients should delve deeper, read labels.
• Dried fruits: While, in general, dried fruits have a low to moderate glycemic index and might not immediately interfere with glycemic control due to their small volume, Pinto with Johns Hopkins said they’re easily overconsumed.
• Flavored yogurts: Often advertised as “low fat” or “fruit added,” or “probiotic,” they can contain up to 15-25 g added sugars per serving, said Pinto. “While plain yogurt consumption is inversely associated with diabetes risk, sweetened versions negate this,” he said. He recommends PCPs direct patients to plain, unsweetened Greek yogurt. “Add fresh berries for sweetness,” he noted.
• ‘No added sugar’ and ‘sugar free’ products: Leading hidden sugars: maltodextrin, maltose, high fructose corn syrup, dextrose, Pinto said, and these sugars can sneak into candies, baked goods, sauces, snacks, dressings, sports drinks, “energy” bars, and “healthy beverages.” Furthermore, a “sugar-free” label is misleading as many products contain hidden starches that contributes to a substantial carbohydrate load, he said.

The Role of the PCP

Communicating the effects of food and physical activity on blood glucose levels is essential.

“The best way to manage the condition of diabetes is to control blood sugar and the best way to control blood sugar is to know which food cause spikes,” said Rekha B. Kumar, MD, an endocrinologist at New York-Presbyterian and Weill Cornell Medicine in New York City.

“As a PCP and endocrinologist, I empower patients to understand that between modifying food and exercise patterns, they can have a tremendous impact on the course of their diabetes. Understanding how food and exercise impact blood sugar and acting on those will limit the amount of medicines needed to manage diabetes.”

Pinto and Doerfler reported having no disclosures. Kumar is a consultant for Found Health, Inc., and an advisory/scientific board member for Skye Bioscience INC.