Nutrition Therapy Recommendations for the Management of Adults With Diabetes

Abstract

A healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat. It is the position of the American Diabetes Association (ADA) that there is not a "one-size-fits-all" eating pattern for individuals with diabetes. The ADA also recognizes the integral role of nutrition therapy in overall diabetes management and has historically recommended that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider, which includes the collaborative development of an individualized eating plan (1,2). Therefore, it is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and support its implementation.This position statement on nutrition therapy for individuals living with diabetes replaces previous position statements, the last of which was published in 2008 (3). Unless otherwise noted, research reviewed was limited to those studies conducted in adults diagnosed with type 1 or type 2 diabetes. Nutrition therapy for the prevention of type 2 diabetes and for the management of diabetes complications and gestational diabetes mellitus is not addressed in this review.A grading system, developed by the ADA and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations (1) ( Table 1). The level of evidence that supports each recommendation is listed after the recommendation using the letters A, B, C, or E. A table linking recommendations to evidence can be reviewed at http:// professional.diabetes.org/nutrition. Members of the Nutrition Recommendations Writing Group Committee disclosed all potential financial conflicts of interest with industry. These disclosures were discussed at the onset of the position statement development process. Members of this committee, their employers, and their disclosed conflicts of interest are listed in the ACKNOWLEDGMENTS. The ADA uses general revenues to fund development of its position statements and does not rely on industry support for these purposes. GOALS OF NUTRITION THERAPY THAT APPLY TO ADULTS WITH DIABETES▪ To promote and support healthful eating patterns, emphasizing a variety of nutrient dense foods in appropriate portion sizes, in order to improve overall health and specifically to:c Attain individualized glycemic, blood pressure, and lipid goals. General recommended goals from the ADA for these markers are as follows:* c A1C ,7%. c Blood pressure ,140/80 mmHg. c LDL cholesterol ,100 mg/dL; triglycerides ,150 mg/dL; HDL cholesterol .40 mg/dL for men; HDL cholesterol .50 mg/dL for women.

Evaluation of the effectiveness of the Ministry of Food cooking programme on self-reported food consumption and confidence with cooking

“…The characteristics of this group were different from those participating in the quantitative research: 73% (29) were white, 63% (25) were female, 75% (30) were aged under 60 years of age, 53% (21) came from a deprived area in Leeds, and 68% (27) did not report a disability.…”

Dietary salt intake and diabetes complications in patients with diabetes: An overview

“…Dietary salt restriction has been noted as an essential constituent of diabetes care in many guidelines,4, 5, 6, 7 although supportive evidence is apt to depend on studies of participants without diabetes or small short‐term studies of patients with diabetes. On the other hand, some longitudinal studies were recently reported regarding the association between dietary salt intake and diabetes complications in patients with diabetes 8, 9, 10.…”

“…In guidelines for the treatment for diabetes in various countries, medical nutritional therapy is described with an individual chapter, explaining recommendations for macronutrient intake including carbohydrate, protein, and fat and micronutrient intake as typified by salt. Table 1 summarizes recommendations for dietary salt intake by the American Diabetes Association (ADA)5 and European Association for the Study of Diabetes (EASD),6 which lead in the treatment of diabetes in the United States and Europe, and that of the Japan Diabetes Society (JDS) 4. The current goals for daily intake of dietary salt in ADA guidelines are below 5.84 g/d5 and 6 g/d in EASD guidelines 6.…”

“…Table 1 summarizes recommendations for dietary salt intake by the American Diabetes Association (ADA)5 and European Association for the Study of Diabetes (EASD),6 which lead in the treatment of diabetes in the United States and Europe, and that of the Japan Diabetes Society (JDS) 4. The current goals for daily intake of dietary salt in ADA guidelines are below 5.84 g/d5 and 6 g/d in EASD guidelines 6. Further reductions in sodium intake are recommended by these associations for patients with both diabetes and high blood pressure.…”

“…Particularly, consistent dietary salt restriction is emphasized for patients at high risk for arteriosclerosis such as those with diabetes, dyslipidemia, or renal disease 2, 3, 4. Guidelines for the treatment of diabetes throughout the world include recommendations for restriction of dietary salt intake4, 5, 6, 7 to prevent or at least slow the development of diabetes complications related to macroangiopathy such as CVD and microangiopathy such as nephropathy, retinopathy, and neuropathy.…”