Nutrition TherapyNutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Moreover, in clinical practice, nutrition recommendations that have little or no supporting evidence have been and are still being given to persons with diabetes. Accordingly, this position statement provides evidence-based principles and recommendations for diabetes medical nutrition therapy.
Evidence-Based Nutrition
The rationale for this position statement is discussed in the American Diabetes Association technical review "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications," which discusses in detail the published research for each principle and recommendation.
Scientific Evidence Nutrition recommendations for diabetes and related complications were based on scientific knowledge, clinical experience, and expert consensus; however, it was often difficult to discern the level of evidence used to construct the recommendations. To address this problem, the 2002 technical review and this position statement provide principles and recommendations classified according to the level of evidence available using the American Diabetes Association evidence grading system.
Beneficial Nutrition However, the best available evidence must still take into account individual circumstances, preferences, and cultural and ethnic preferences, and the person with diabetes should be involved in the decision-making process. The goal of evidence-based recommendations is to improve diabetes care by increasing the awareness of clinicians and persons with diabetes about beneficial nutrition therapies.
Complexity Of Nutrition Because of the complexity of nutrition issues, it is recommended that a registered dietitian, knowledgeable and skilled in implementing nutrition therapy into diabetes management and education, be the team member providing medical nutrition therapy. However, it is essential that all team members be knowledgeable about nutrition therapy and supportive of the person with diabetes who needs to make lifestyle changes.
Goals Of Medical Nutrition Therapy
1. Attain and maintain optimal metabolic outcomes including
* Blood glucose levels in the normal range or as close to normal as is safely
possible to prevent or reduce the risk for complications of diabetes.
* A lipid and lipoprotein profile that reduces the risk for macrovascular disease.
Blood pressure levels that reduce the risk for vascular disease.
2. Prevent and treat the chronic complications of diabetes. Modify nutrient intake
and lifestyle as appropriate for the prevention and treatment of obesity,
dyslipidemia, cardiovascular disease, hypertension, and nephropathy.
3. Improve health through healthy food choices and physical activity.
4. Address individual nutritional needs taking into consideration personal and
cultural preferences and lifestyle while respecting the individual's
Common Food Carbohydrates Nutrition health When referring to common food carbohydrates, the following terms are preferred: sugars, starch, and fiber. Terms such as simple sugars, complex carbohydrates, and fast-acting carbohydrates arc not well defined and should be avoided Studies in healthy subjects and those at risk for type 2 diabetes support the importance of including foods containing carbohydrate, particularly from whole grains, fruits, vegetables, and low-fat milk in the diet of people with diabetes.
Factors Influencing Glycemic Responses A number of factors influence glycemic responses to foods, including the amount of carbohydrate, type of sugar (glucose, fructose, sucrose, lactose), nature of the starch (amylose, amylopectin, resistant starch), cooking and food processing (degree of starch gelantinization, article size, cellular form), and food form, as well as other food components (fat and natural substances that slow digestion--lectins, phytates, tannins, and starch-protein and starch-lipid combinations).