1. History and current status Diabetic diet therapy is an important measure in the treatment of diabetes and is one of the components of the so-called five carriages (diet, medication, exercise, education, and testing) in the treatment of diabetes. However, its status has often been placed in a secondary position. Medication has been particularly prevalent in the last century. In retrospect, the dietary composition was adopted as far back as ancient Egypt with high carbohydrate therapy in BC and continued for many centuries after A.D. In 1797 John Rollo proposed a low-carbohydrate, high protein, high fat calorie regimen and in 1912 Fredenrich M. Allen proposed a low of all three. However, since 1940 the American Diabetes Association (ADA) once again proposed a high carbohydrate, low protein, high fat calorie scheme. Since then, the ADA has increased the carbohydrate component from 40% to 45% and decreased the fat component from 40% to 35%. 1986 onwards it was set at <60%. Protein 10-20% remained unchanged, and fat was reduced to <30%. The diet of our population is based on carbohydrates as the main component. The diet of diabetic patients is also based on carbohydrates as the main source of calories. The column of "Nutrition Principles" in "Practical Goals and Treatment of Type 2 Diabetes", which was issued in 2002 and developed by the Asia-Pacific Type 2 Diabetes Policy Group, suggests that proper weight control, 25-30% of total calories should come from fats and oils; 55-65% of total calories should be provided by carbohydrates; protein should not exceed the required amount --The 2004 Chinese Diabetes Prevention and Control Guidelines state that 20-30% of total dietary calories should come from fats and oils; carbohydrates should provide 55-65% of total calories; and protein should not exceed requirements, i.e., no more than 15% of total calories. In 2006, the American Diabetes Association's "Practical Clinical Recommendations" for Medical Nutrition Therapy (MNT) set a range of 45%-65% for carbohydrates. In this recommendation, it is clearly stated that a low-sugar diet is not recommended for diabetic patients, and that DM patients should not limit carbohydrates (sugars) to less than 130g per day. The American Diabetes Association 2007 edition of diabetes diagnosis and treatment standards in the MNT recommendations: for diabetes and obesity treatment emphasizes lifestyle changes, including education, reduction of energy and fat intake (< 30% of total energy), regular physical activity can reduce the original weight of 5-7%. Fat intake, saturated fat intake <7% of total calories, minimal use of trans fats; monitoring carbohydrate amounts by calculation, food exchange portions, or empirical estimation remains the key to achieving glycemic control, and a low-carbohydrate diet (restricted carbohydrate <130g/d) is not recommended for the treatment of overweight/obesity. 2007 ADA recommendations are an improvement over previous recommendations, but still advocate high carbohydrate , low-fat, and low-protein calorie regimens, and does not adopt a low-carbohydrate diet approach. However, in recent years, low-carbohydrate, high-fat, high-protein calorie diets have become popular in American society to lose weight and treat diabetes, which is a new change worthy of the world's attention. 2, innovation and effect in the United Kingdom, due to obesity patients more, as early as thirty years ago has been attached importance, then that obesity is due to more fat caused by eating. 1977, the United States Senate published the "United States dietary goals", requiring people to reduce the intake of fat, less meat, more rice and flour food. Later, the U.S. Department of Agriculture proposed a "low-fat, high-sugar guideline pagoda. The intake of sugar and refined carbohydrates was increased, and the intake of fat was restricted. However, after thirty years of practice, the United States obese people not only did not see a reduction, but also a year-on-year increase in the number of diabetic patients also increased significantly, and there is a surge of children with diabetes. Make Cleave (T.L. Cleave) 20-year rule has been verified. Cleave's 1974 book, The Sugar Disease, concluded that once refined sugars (carbohydrates) were introduced into the diets of others, replacing their original foods, diabetes and heart disease would appear in the population within 20 years, and within 40 years, these diseases would spread. The change in the American diet has created a nightmare, and it has spread globally, with obesity and metabolic syndrome already spreading to a global catastrophe. The consequences are of great concern to many knowledgeable Americans. Cardiovascular academic Atkins (RobertC.AKins) published his first book "Dr. Atkins' Diet Revolution" as early as 1972 in which he first proposed his new concept of diet, different from the traditional low-calorie, low-fat, high-sugar diet, arguing that calories and fat are not the determinants of obesity and advocating a high-protein, low-sugar (carbohydrate) diet. In Atkins' book The Anti-Aging Diet (2001), it is stated that there are 15 million people with diabetes in the United States today and probably four times that number with antecedent diabetes. Insulin resistance is a major factor in this, which in turn is associated with the consumption of refined sugar foods. Diet has been linked to obesity, diabetes and heart disease, especially with sugary foods. He believes that refined sugary foods are actually the largest unrecognized cause of death in history. Therefore, the principle of low sugar was strongly advocated in his dietary regimen. He believed that blood sugar levels were unstable due to sugar, that it was largely unaffected by protein, and that it was stabilized by food fats and oils. If you have problems with unstable blood sugar, a diet low in sugars and moderately high in fat may help normalize it. Professor WalterWillett, Chair of the Department of Nutrition at Harvard University, George Blouchburn, Professor at Harvard Medical School and former President of the American Society for Clinical Nutrition, and Professor SamKlein, Director of the Center for Human Nutrition at the University of Washington and former President of the North American Association for the Study of Obesity, have been engaged for many years in low The study of low-carbohydrate diets. Around 2000, U.S. scientists proposed the important concept of a healthy diet with low-carbohydrate supplementation and the Harvard Healthy Diet Tower, which put refined rice flour from the bottom to the top of the USDA Dietary Tower. These Harvard scientists believe that refined white rice, white bread and pasta not only cannot be used as a major source of calories (55%-65%); instead, these foods can be called junk food and need to be avoided or strictly controlled. The use of this low-carbohydrate diet to treat obesity and diabetes can achieve remarkable results. The main principle of using this diet therapy to treat diabetes is sugar-free low-carbohydrate and nutritional supplementation. By reducing the intake of sugar and refined carbohydrates and replenishing a variety of nutritional elements that diabetics are most deficient in, we can achieve lower postprandial blood glucose, reduce the load on pancreatic islet cells, reduce blood glucose fluctuations and restore nutritional balance, so as to repair the already damaged pancreatic islet cells and improve the body's ability of antioxidant and free radical scavenging. to reduce insulin resistance and restore islet cell function. At the same time, supplemented with reasonable exercise, blood sugar control and nutritional balance can be achieved. It is possible not to use or stop the use of hypoglycemic drugs, including oral hypoglycemic drugs or insulin injections. Recently, many foreign scholars have found that a high-protein, high-fat, low-sugar diet not only does not increase the weight of obese insulin-resistant diabetic patients, but also reduces their weight and improves their blood glucose, blood lipids, and sensitivity to insulin. Low-sugar, high-protein diet (LC/HP) is another popular diet for weight loss abroad, which refers to a total sugar intake of <35g or <20%-30% in a day, with no special restrictions on fat. The effectiveness of low-sugar diets has also been confirmed by some research reports in recent years. For example, Nielsen et al. (2005) reported the results of their study in which 16 obese type 2 diabetic patients were subjected to a comparative study of a low-sugar diet and a high-sugar diet to compare the effects of these two different diets on the patients' blood glucose and body weight. BodenG (2005) also published the effects of a low-sugar, high-protein, and high-fat diet on diet, body weight, energy intake and expenditure, blood glucose, insulin sensitivity, and blood lipids in obese patients with type 2 diabetes. The results showed that a low-sugar diet resulted in lower energy intake and reduced body weight. 24-hour blood glucose fluctuations were in the normal range. Mean HbA1c decreased from 7.3% to 6.8%, insulin sensitivity increased by 75%, and mean triglycerides and cholesterol decreased by 35% and 10%, respectively. The author recently saw a case of a younger obese diabetic patient (42 years old, male, weight 85 kg) who was found to have significantly higher blood glucose in April 2006, along with hypertension and urine glucose 3+. He was on a self-administered sugar-free, carbohydrate-free, high protein-calorie diet. The responding physician recommended the application of insulin pump booster therapy in view of his high blood glucose and condition, which was not accepted by the patient. However, after treatment with this simple carbohydrate-free therapy, blood glucose dropped quickly and weight loss was faster. There was little increase in exercise. Since then, the blood glucose has stabilized within the normal range, and the amount of carbohydrates added to the diet is still small. Now it has been one and a half years, still no additional hypoglycemic drugs (oral drugs or insulin injection), blood sugar remains stable, body size has been close to normal, blood pressure normal range. The author had a case of male type 2 diabetes mellitus patient, only to reduce the intake of carbohydrates, appropriate to increase the amount of physical activity (exercise), 2 months after the blood glucose into the normal range, and can maintain long-term stability, the original body shape slightly obese, after this treatment, weight loss. From the above information, this diet structure of low carbohydrate, high protein, high fat calories and appropriate nutrient supplementation can be considered as an innovation in diabetes treatment, which is beneficial to obese patients with type 2 diabetes and may not be supplemented with hypoglycemic drugs. Of course, there should also be a conditional selection of patients to ensure safety. The fats consumed are also mainly beneficial to the health of the fat to be selected. 3. Discussion and Suggestions The number of people suffering from diabetes in China has increased rapidly in recent years, 95% of which are type 2 diabetes and developing in the underage. These patients 80% existing or have had obesity. Generally obesity in the first, diabetes subsequently occurred. Therefore, the prevention of obesity can effectively prevent and control type 2 diabetes. Abroad, in recent years, a sugar-free, low-carbohydrate diet is a new and effective measure to prevent and treat obesity. This method to prevent and control type 2 diabetes should also be effective. Overseas, there have been a large number of studies to achieve results. There are few large-scale studies in China, and we need practical experience in this area. If this low-carbohydrate therapy is further proven and promoted, it will bring great benefits to people with diabetes and to society. The mainstream treatment of diabetes is still dominated by medication, and diet is not the dominant treatment, although it has been listed as the basis of diabetes treatment. In the 2007 edition of the U.S. Diabetes Standards of Care, the first step in the metabolic treatment process for type 2 diabetes is listed in the diagram (Figure 1): lifestyle intervention + metformin. Lifestyle refers to dietary therapy and exercise. Thereafter, if the HbA1c is ≥ 7%, treatment with either plus insulin, or plus sulfonylurea, or plus glitazones is used. If still HbA1c ≥ 7%, further intensification of drug therapy is required. However, if low-carbohydrate dietary therapy is effective for type 2 diabetes, especially in obese individuals. Then can it be treated and observed first with diet therapy and exercise once diagnosed, and can metformin be disregarded first? This is a question worth exploring. According to the experience gained abroad, it can be considered. Even if HbA1c≥7%, for obese type 2 diabetic patients, if there are no chronic complications, low-carbohydrate diet therapy can be applied when conditions permit. Of course, in China, there is a lack of indications or rules for the application of such dietary therapy, and there is no mature experience in the dietary formula for this therapy (suitable for our national conditions and dietary habits), so we need to conduct research and develop. Chen Chaogang et al. (2007) concluded that low glycemic index (LGI) diets can effectively control blood glucose and lipid levels, reduce insulin resistance and improve nutritional intake in patients with type 2 diabetes. Refined sugars (carbohydrates) have a high glycemic index, and there is a good reason to try to avoid these refined sugary foods in the composition of low-carbohydrate diets abroad. We can combine the two and develop our own low-carb chemotherapy recipes, which may be more suitable for our national conditions. We expect to start a wave of research and application of new low-carbohydrate diet therapy in our country for the majority of patients with type 2 diabetes, obesity and metabolic syndrome. A: Pay attention to the progress and feasibility of low-carbohydrate diet therapy. B: Observe the low-carbohydrate therapy cautiously in obese patients with type 2 diabetes with suitable conditions and actively accumulate experience. C: Prepare a medical nutrition therapy group in the provincial endocrine diabetes society to design a research program for diabetic obesity, to communicate and promote low-carbohydrate therapy.