Le régime excluant les glucides est apparu comme le seul moyen de contrôler le diabète dès lors que la présence de sucre dans les urines a été rattachée aux aliments. De John Rollo, le premier à avoir préconisé un régime spécifique, en 1797, à Frederick M. Allen et Eliott P. Joslin, partisans des régimes de famine (starvation diet), de nombreuses formules de régime ont été imaginées avant la découverte de l’insuline. Après une période de rigueur diététique, l’ère post-insulinique a été marquée par des controverses opposant les pédiatres partisans du régime libre, qui privilégiaient la qualité de vie, aux médecins d’adultes intransigeants, qui étaient obsédés par la prévention des complications à long terme. La meilleure connaissance des aliments glucidiques et la mise au point de l’indice glycémique ont bouleversé la diététique du diabète. Toujours incontournable, elle est devenue plus réaliste, plus compatible avec la vie quotidienne, et intègre la notion de plaisir alimentaire. Aujourd’hui, le régime diabétique a pour objectif de contribuer à l’équilibre glycémique, mais aussi de prévenir les complications cardiovasculaires et de gérer le poids.

Free-carbohydrate diets were proposed to correct glycemic disorders of persons with diabetes as soon as it was discovered that food intake could be associated with the presence of sugar in urine. Throughout the last past centuries, the evolution of dietary recommendations for diabetes was a long itinerary paved with many changes and obstacles. Starting in 1797 with the John Rollo’s specific diet and followed by starvation diets such as those promoted by Frederick M. Allen and Eliott P. Joslin, a non-interrupted series of imaginative dietary proposals was observed before the insulin discovery. After a period characterized by the prescription of severe carbohydrate-restricted diets, new recommendations emerged. However, the post-insulin era was also marked by controversies between pediatricians and healthcare professionals involved in the management of adults with diabetes. For maintaining the quality of life of their young patients, the pediatricians encouraged them to use freestyle nutritional behaviors. By contrast, physicians for adults were more specifically and deeply concerned by the primary and secondary prevention of long-term adverse outcomes. The better knowledge of carbohydrate-containing foods and introduction of glycemic indexes as a method for assessing and classifying the glycemic responses to foods have markedly modified the landscape of diets to be prescribed in diabetes. Dietary measures are still and more than ever considered the first line treatment of diabetes. However, it should be mentioned that the recommendations have progressively evolved to become more realistic and less constraining by integrating as much as possible the hedonic components/concepts of contemporary nutrition. Nowadays it appears that diets should not be limited to improving the glycemic control and maintaining the patient’s body weight within reasonable limits, but must also be extended to lowering the risk for the development of diabetic complications.