Symposium ArticleDiabetes Nutrition Therapy: Effectiveness, Macronutrients, Eating Patterns and Weight Management☆
Introduction
As research provides evidence for the role of nutrition therapy in diabetes management, it is important that traditional nutrition therapy advice given to individuals with diabetes be updated to reflect the latest evidence. The goal of diabetes nutrition therapy is to implement interventions that promote healthy eating and assist in achieving glucose, lipid and blood pressure goals.1, 2 The first question, and perhaps the most important, is: what is the evidence that diabetes nutrition therapy is effective, and if effective, what nutrition therapy interventions result in positive metabolic outcomes. Second, are there ideal percentages of macronutrients and eating patterns that should be recommended to persons with diabetes? Third, what is the role of weight loss interventions (WLIs) across the continuum of diabetes management, from prevention to management of diabetes?
Medical recommendations, including those for nutrition therapy, are now being developed using an evidence-based approach. The Academy of Nutrition and Dietetics is currently updating their evidence-based nutrition recommendations for type 1 and type 2 diabetes published in 20101 and The American Diabetes Association (ADA) in 2013 published nutrition therapy recommendations for management of adults with diabetes using a similar process.2 Both are the basis for the recommendations cited in this article. This article (1) reviews effectiveness and outcomes of diabetes nutrition therapy and nutrition therapy interventions that are effective, (2) examines evidence that supports recommendations for diabetes-related macronutrient intake and eating patterns and (3) reviews the role of WLIs in the management of type 2 diabetes.
Section snippets
Effectiveness of Diabetes Nutrition Therapy
Multiple studies provide evidence that across the diabetes continuum, diabetes nutrition therapy is effective for improving glycemic control and other metabolic outcomes. Of importance are the clinical trials that document the effectiveness of nutrition therapy for the prevention or delay of type 2 diabetes. Lifestyle interventions—an eating plan that facilitates moderate weight loss (5-7% of body weight) and increased physical activity (equivalent to 30 minutes brisk walking on most days of
Macronutrients and Eating Patterns
In the United States, most adults and youth with type 1 or type 2 diabetes report eating moderate amounts of carbohydrate (approximately 46-48% of total energy intake) and approximately 35-40% of energy intake from fat with the remainder from protein.6, 7 The ADA׳s review of evidence concluded that there is no most effective mix of carbohydrate, protein and fat that applies broadly; macronutrient proportions should be individualized and adjusted to meet metabolic goals and preferences of the
The Role of WLIs in the Management of Diabetes
Overweight and obesity are common health problems in persons at risk for and with type 2 diabetes and weight loss is frequently recommended as the solution to improve glycemic control.2 In persons with prediabetes, modest amounts of weight loss and regular physical activity are effective in preventing or delaying the onset of type 2 diabetes.26 In individuals who have maintained lifestyle strategies for prevention of diabetes, the effectiveness of these strategies has been maintained for 15
Conclusions
Based on the evidence reviewed, the question becomes—what is the best nutrition therapy for diabetes? In an “ideal world,” the evidence suggests that all persons with type 2 diabetes would lose 5-10% of their baseline weight, have a nutrient-dense eating pattern in appropriate portion sizes and participate in 150 min per week of regular physical activity. All persons with type 1 diabetes would count carbohydrates, adjust premeal insulin based on insulin-to-carbohydrate ratios and use insulin
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2021, Diabetes Research and Clinical PracticeCitation Excerpt :Guidelines for people with T2D recommend nutritional therapy alongside physical activity as part of the basic therapy in the first stage of the therapy algorithm [29,30]. Evidence is based on clinical studies showing that nutritional therapy positively influences therapeutic goals (HbA1c, lipids, blood pressure, and quality of life) [13,31]. Further goals of nutritional therapy for people with T2D are often weight reduction and prevention of chronic complications.
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2023, ACM International Conference Proceeding SeriesMedical nutrition therapy guidelines for diabetes in adults
2023, Lijecnicki Vjesnik
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The authors have no financial or other conflicts of interest to disclose.