The American Diabetes Association (ADA) published a new guidance report regarding individualization of nutrition goals in diabetes care, including strategies for weight management and the prevention of diabetes complications. For the first time, the updated report also includes nutrition interventions for adults diagnosed with prediabetes.
The panel reviewed more than 600 nutrition manuscripts published between 2014 and 2018 for the update, which has been incorporated into the ADA’s 2019 Standards of Medical Care.
A summary of the consensus recommendations follows.
● There is no single recommended nutrition plan for patients with diabetes. Factors such as food availability, socioeconomic circumstances, and cultural preferences must be taken into consideration due to the broad spectrum of people affected by diabetes.
● For people with or at risk for diabetes, evidence does not suggest an ideal caloric carbohydrates, protein, and fat intake. Various combinations of food groups are acceptable.
● Current eating patterns, metabolic goals, and preferences should be assessed in order to personalize macronutrient distribution.
● Management of weight was recommended as an essential component of care in people with type 1 diabetes (T1D) who are overweight or obese and subject to worsening of insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors.
● The panel emphasized that it is critical to maintain and sustain an eating plan that results in a deficit of energy, regardless of macronutrient composition or eating pattern to promote weight loss.
● Healthcare providers are advised to focus on important dietary factors such as consuming nonstarchy vegetables; minimizing added sugars and refined grains; and choosing whole, unprocessed foods over processed foods.
● The panel recommended replacing sugar-sweetened beverages with water when possible. They also noted that replacing sugar with sugar substitutes does not make an unhealthy option healthy.
● Saturated fat should be replaced with unsaturated fat to reduce low-density lipoprotein cholesterol, total cholesterol, and the risk for cardiovascular disease.
● Research indicates that reductions in hemoglobin A1c with medical nutrition therapy in type 2 diabetes (T2D) can be equal to or greater than reductions with medications.
● Medical nutrition therapy can be important in the management and prevention of diabetes complications including gastroparesis, cardiovascular disease, and chronic kidney disease.
● National data suggest that people with diabetes do not receive any formal diabetes education, so referring adults with T1D or T2D to personalized, diabetes-focused medical nutrition therapy upon diagnosis and throughout life is an imperative component of care.
For patients with prediabetes, the panel made the following recommendations.
● Referral to an intensive behavioral lifestyle intervention program to improve eating habits, increasing physical activity to at least 150 min/wk, and a 7% to 10% loss of initial body weight if indicated.
● Counseling by healthcare providers should focus on prevention and diagnosis and treatment of disordered eating.
William Cefalu, MD, the ADA’s Chief Scientific, Medical, and Mission Officer, stated that the ADA “strongly encourages an individualized approach that includes regular review of nutrition status for all people living with diabetes. Reassessment of an individual’s nutritional plan is particularly important during significant life and health status changes… Working with a team of health providers including a registered dietician or certified diabetes educator is fundamental to effectively manage[ing] diabetes and prediabetes.”
New Consensus Report Recommends Individualized Eating Plan to Meet Each Person’s Goals, Life Circumstances and Health Status [news release]. Arlington, VA: American Diabetes Association; April 18, 2019. www.prnewswire.com/news-releases/new-consensus-report-recommends-individualized-eating-plan-to-meet-each-persons-goals-life-circumstances-and-health-status-300834778.html. Accessed April 18, 2019.