Malnutrition in patients with diabetes. The role of oral nutritional supplements in nutritional therapy Review article
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Published:
May 31, 2026
Keywords:
diabetes, malnutrition, nutritional therapy, oral nutritional supplements, ONS
Main Article Content
Abstract
Malnutrition is a common yet frequently underrecognized problem in patients with diabetes, significantly affecting disease course, glycaemic control and overall prognosis. Nutritional disorders may occur regardless of body weight and affect both ambulatory and hospitalized patients, particularly older individuals and those with chronic diabetic complications and comorbidities. Malnutrition contributes to the development of sarcopenia, increases the risk of hypoglycaemia and infectious complications, and is associated with prolonged hospital stay and increased mortality. Nutritional therapy is an integral component of comprehensive diabetes management and should be initiated early and tailored to individual patient needs. When a conventional diet fails to meet energy and protein requirements, oral nutritional supplements, classified as foods for special medical purposes, play an important role. Appropriately selected oral nutritional supplements, designed to address the specific metabolic needs of patients with diabetes, may effectively improve nutritional status without adversely affecting glycaemic control and represent a valuable adjunct to dietary management in this patient population.
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How to Cite
Sosnowska, M., & Czupryniak, L. (2026). Malnutrition in patients with diabetes. The role of oral nutritional supplements in nutritional therapy. Medycyna Faktow (J EBM), 19(1(70), 13-18. https://doi.org/10.24292/01.MF.0126.2
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References
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28. Polskie Towarzystwo Diabetologiczne. Zalecenia kliniczne dotyczące postępowania u osób z cukrzycą – 2026. Stanowisko Polskiego Towarzystwa Diabetologicznego. Curr Top Diabetes. 2026; 6(1): 1-175.
2. Wadivkar P, Thomas N, Jebasingh F et al. Undernutrition-associated diabetes mellitus: Pathophysiology of a global problem. Physiology (Bethesda). 2025; 40(5): 0.
3. Zhang T, Qin J, Guo J et al. Prevalence and influencing factors of malnutrition in diabetic patients: A systematic review and meta-analysis. J Diabetes. 2024; 16(10): e13610.
4. Tamura Y, Omura T, Toyoshima K et al. Nutrition management in older adults with diabetes: Importance of shifting prevention strategies from metabolic syndrome to frailty. Nutrients. 2020; 12(11): 3367.
5. Salom Vendrell C, García Tercero E, Moro Hernández JB et al. Sarcopenia as a little-recognized comorbidity of type II diabetes Mellitus: a review of the diagnosis and treatment. Nutrients. 2023; 15(19): 4149.
6. Schuetz P, Seres D, Lobo DN et al. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021; 398(10314): 1927-38.
7. Barazzoni R, Sievenpiper JL, Genton L et al. Sarcopenic diabetes is an under-recognized and unmet clinical priority. A call for action from the European Society for Clinical Nutrition and Metabolism and the Diabetes Nutrition Study Group. Clin Nutr. 2025; 55: 208--18.
8. Via M. The malnutrition of obesity: Micronutrient deficiencies that promote diabetes. Int Sch Res Notices. 2012; 2012: 103472.
9. Cederholm T, Jensen GL, Correia MITD et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019; 38(1): 1-9.
10. Mesinovic J, Zengin A, De Courten B et al. Sarcopenia and type 2 diabetes mellitus: A bidirectional relationship. Diabetes Metab Syndr Obes. 2019; 12: 1057-72.
11. Ahmed N, Choe Y, Mustad VA et al. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care. 2018; 6(1): e000471.
12. Yamamoto S, Hashimoto Y, Takahashi F et al. Mortality risk of sarcopenia and malnutrition in older patients with type 2 diabetes mellitus. Nutrients. 2025; 17(16): 2622.
13. Khazrai YM, Defeudis G, Pozzilli P. Effect of diet on type 2 diabetes mellitus: a review. Diabetes Metab Res Rev. 2014; 30(S1): 24-33.
14. Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr. 2014; 33(5): 737-48.
15. Gau BR, Chen HY, Hung SY et al. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers. J Diabetes Complications. 2016; 30(1): 138-42.
16. Maier HM, Ernst JI, Arjmandi B et al. Deficiencies in nutritional intake in patients with diabetic foot ulcers. J Nutr Ther. 2016; 5(4): 85-92.
17. Lauwers P, Dirinck E, Van Bouwel S et al. Malnutrition and its relation with diabetic foot ulcer severity and outcome: a review. Acta Clin Belg. 2022; 77(1): 79-85.
18. Cortés-Aguilar R, Malih N, Abbate M et al. Validity of nutrition screening tools for malnutrition risk. Clin Nutr. 2024; 43(5): 1094-116.
19. Singer P, Blaser AR, Berger MM et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019; 38(1): 48-79.
20. Hubbard GP, Elia M, Holdoway A et al. Compliance to oral nutritional supplements. Clin Nutr. 2012; 31(3): 293-312.
21. Thomson KH, Rice S, Arisa O et al. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev. 2022; 3(10): e654-e666.
22. Mayr P, Kuhn KS, Klein P et al. A diabetes-specific oral nutritional supplement improves glycaemic control in type 2 diabetes patients. Exp Clin Endocrinol Diabetes. 2016; 124(7): 401-9.
23. Magnoni D, Rouws CH, Lansink M et al. Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients. Diabetes Res Clin Pract. 2008; 80(1): 75-82.
24. Cadogan CA, Dharamshi R, Fitzgerald S et al. A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care. Clin Nutr. 2020; 39(3): 654-63.
25. Evert AB, Dennison M, Gardner CD et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019; 42(5): 731-54.
26. Ojo O, Ojo OO, Adebowale F et al. The effect of dietary glycaemic index on glycaemia in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2018; 10(3): 373.
27. Dardai E. Basics in clinical nutrition: Nutritional support in the diabetic patient. Eur e-J Clin Nutr Metab. 2009; 4(6): e304-7.
28. Polskie Towarzystwo Diabetologiczne. Zalecenia kliniczne dotyczące postępowania u osób z cukrzycą – 2026. Stanowisko Polskiego Towarzystwa Diabetologicznego. Curr Top Diabetes. 2026; 6(1): 1-175.