Diabetes-Specific Nutrition Algorithm: A Transcultural Program to Optimize Diabetes and Prediabetes Care

Abstract

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

Glycemia Targeted Specialized Nutrition (GTSN) improves postprandial glycemia and GLP-1 with similar appetitive responses compared to a healthful whole food breakfast in persons with type 2 diabetes: a randomized, controlled trial

“…However, diabetes dietary guidelines can be cumbersome. Due to their ease of use and previously discussed efficacy, meal or calorie replacements that are also glycemia-targeted have been incorporated as a recommended tool in several diabetesspecific nutritional plans [33,34] and within the recently published Transcultural Diabetes-specific Nutritional Algorithms [4][5][6]. This study demonstrates that breakfast consumption in people with T2DM can be metabolically beneficial when appropriate glycemia-targeted breakfast choices are made and supports the use of GTSN at the breakfast eating occasion as recommended in the Transcultural Diabetes-specific Nutrition Algorithms [4][5][6].…”

“…Medical nutrition therapy is a critical part of globally accepted treatment guidelines for type 2 diabetes mellitus (T2DM) [1][2][3][4][5][6]. An important feature of these nutrition therapeutic guidelines is attention to type and amount of carbohydrate and calorie control leading to weight management.…”

“…Glycemia Targeted Specialized Nutrition (GTSN) such as the meal replacements utilized in the LookAHEAD [7,8] and Sun et al [9], trials have been included as an integral part of a recently published Transcultural Nutrition Algorithm that advocates lifestyle modification as an adjunct to pharmacotherapy [4][5][6]. GTSN formulas containing low glycemic index and slowly digested carbohydrates were shown to exert better glycemic management as compared to standard formulas [9,[14][15][16][17][18][19] when used as a meal or calorie replacement or as a dietary supplement as part of overall nutritional management of diabetes [reviewed in 16].…”

The Transcultural Diabetes Nutrition Algorithm

“…The tDNA template details overarching goals and is culturally specific to Caucasian Americans [31]. The transculturally adapted manuscripts detail variants for Southeast Asian [43], Asian-Indian [44], Canadian [45], Malaysian [46], and Venezuelan populations [47].…”

“…The final guidance within the tDNA applications is related to indications for bariatric surgery [31]. Although the decision to undergo a major elective surgery is an important physicianÀpatient discussion, the tDNA algorithms provide some basic guidelines to aid in identifying patients appropriate for surgical consideration (Table 22.10).…”