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Lowering salt intake benefits people with diabetes
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Lowering salt intake benefits people with diabetes
Does salt restriction have an effect on the prevention and progression of chronic kidney disease in people with diabetes?
The available data from this systematic review of randomised controlled trials, assessing salt restriction, indicate that lowering sodium intake may reduce blood pressure in participants with type 1 and type 2 diabetes, with and without hypertension, and with normal or slightly abnormal kidney function.
In 7 long-term studies (treatment duration 4 to 12 weeks), the median net reduction in 24-hour urine sodium excretion was 76mmol, ranging from 51mmol to 124mmol. In 10 short-term studies (treatment duration 5 to 7 days), the median net reduction was 187mmol, with a range of 86mmol to 337mmol.
Sodium restriction may reduce systolic blood pressure by 7.36mmHg, diastolic blood pressure by 3.17mmHg and mean arterial pressure by 3.01mmHg in all participants. Only one study identified orthostatic hypotension more frequently in participants receiving a reduced sodium diet.
Lowering dietary salt intake to the recommended level of 5g per day or less would benefit people with diabetes, with or without hypertension or evidence of kidney disease, by lowering blood pressure by similar amounts as a single blood pressure medication.
No studies addressed the outcomes of cardiovascular events (stroke, heart failure, myocardial infarction). The number of studies on the effects of salt reduction in people with diabetes was limited, and the majority of available studies were of short duration with few included participants. The results show considerable heterogeneity, particularly among studies lasting only 1 to 2 weeks. All analyses were considered to be of low-certainty evidence.
There is strong evidence that our current consumption of salt is a major factor in the development of increased blood pressure and that a reduction in salt intake lowers blood pressure, whether blood pressure levels are normal or raised initially. Effective control of blood pressure in people with diabetes lowers the risk of strokes, heart attacks and heart failure, and slows the progression of chronic kidney disease.
Hodson EM, Cooper TE. Altered dietary salt intake for preventing diabetic kidney disease and its progression. Cochrane Database Syst Rev 2023;1:CD006763. This review contains 13 trials with a total of 313 participants.