Symposium Article
Diabetes Nutrition Therapy: Effectiveness, Macronutrients, Eating Patterns and Weight Management

https://doi.org/10.1016/j.amjms.2016.02.001Get rights and content

Abstract

Background

Diabetes nutrition therapy provided for individuals with diabetes must be based on research documenting effectiveness. The roles of differing macronutrient percentages, eating patterns and weight loss interventions are controversial.

Methods

A review of research related to these topics is summarized.

Results

Clinical trials as well as systematic reviews and Cochrane reviews report an approximately 1-2% lowering of hemoglobin A1c as well as other beneficial outcomes from nutrition therapy interventions, depending on the type and duration of diabetes and level of glycemic control. There are no ideal percentages of macronutrients or eating patterns or both that apply to all persons with diabetes. Clinical trials demonstrate the effectiveness of modest weight loss and physical activity for the prevention or delay of type 2 diabetes. However, as the disease progresses, weight loss interventions may or may not result in beneficial glycemic and other metabolic outcomes.

Conclusions

To be effective, diabetes nutrition therapy must be individualized. Treatment goals, personal preferences (eg, tradition, culture, religion, health beliefs and economics) and the individual׳s ability and willingness to make lifestyle changes all must be considered when educating or counseling individuals with diabetes. A healthy eating pattern emphasizing nutrient-dense foods in appropriate portion sizes, regular physical activity and support are important. A reduced energy intake for persons with prediabetes or type 2 diabetes and matching insulin to planned carbohydrate intake for insulin users is nutrition therapy interventions shown to be effective in achieving glycemic and other metabolic outcomes.

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

References (34)

  • J.G. Pastors et al.

    Effectiveness of medical nutrition therapy in diabetes

  • DAFNE Study Group

    Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjusted for normal eating (DAFNE) randomised controlled trial

    Br Med J

    (2002)
  • R. Rabasa-Lhoret et al.

    Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with basal-bolus (ultralente-regular) insulin regimen

    Diabetes Care

    (1999)
  • C.E.M. Smart et al.

    Both dietary protein and fat increase postprandial glucose concentrations in children with type 1 diabetes, and the effect is additive

    Diabetes Care

    (2013)
  • C.E. Smart et al.

    Children and adolescents on intensive insulin therapy maintain postprandial glycemic control without precise carbohydrate counting

    Diabet Med

    (2009)
  • M.A. Paterson et al.

    Influence of dietary protein on postprandial blood glucose levels in individuals with type 1 diabetes mellitus using intensive insulin therapy

    Diabet Med

    (2015)
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    The authors have no financial or other conflicts of interest to disclose.

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