Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Multiple meal planning approaches and eating patterns can be effective for achieving metabolic goals. The ADA Diabetes Food Pyramid clearly groups foods depending their protein and carbohydrate content. In addition, lower A1C occurred in the Diabetes Control and Complications Trial (DCCT) intensive-treatment group and the Dose Adjustment For Normal Eating (DAFNE) trial participants who received nutrition therapy that focused on the adjustment of insulin doses based on variations in carbohydrate intake and physical activity (13,123). Based on 18 trials, the authors found that isocaloric exchange of fructose for carbohydrates reduced glycated blood proteins and did not significantly affect fasting glucose or insulin. If you have diabetes, it is important to learn about carbohydrates found in food. Wylie-Rosett J, Segal-Isaacson CJ, Segal-Isaacson A: Carbohydrates and increases in obesity: does the type of carbohydrate make a difference? There is no standard meal plan or eating pattern that works universally for all people with diabetes (1). If adults with diabetes choose to drink alcohol, they should be advised to do so in moderation (one drink per day or less for adult women and two drinks per day or less for adult men). Long-term reduction of adiposity is difficult for most people to achieve, and even harder for individuals with diabetes to achieve given the impact of some medications used to improve glycemic control (e.g., insulin, insulin secretagogues, and thiazolidinediones) (59,60). A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. On average, it has been observed that people with diabetes eat about 45% of their calories from carbohydrate, 3640% of calories from fat, and the remainder (1618%) from protein (8991). (B), For individuals with both diabetes and hypertension, further reduction in sodium intake should be individualized. Use of this heart medication with L-arginine might cause your blood pressure to become too low. Proteins effect on blood glucose levels in type 1 diabetes is less clear (165,166). (A), As recommended for the general public, an increase in foods containing long-chain omega-3 fatty acids (EPA and DHA) (from fatty fish) and omega-3 linolenic acid (ALA) is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies. A higher carb intake makes controlling glucose and losing weight more of a challenge. It should be noted that these studies had low retention rates, which may lead to loss of statistical power and biased results (110,113,116). Mayer-Davis EJ, Dhawan A, Liese AD, Teff K, Schulz M: Towards understanding of glycaemic index and glycaemic load in habitual diet: associations with measures of glycaemia in the Insulin Resistance Atherosclerosis Study. Therefore this position statement offers evidence-based nutrition recommendations for all health care professionals to use. Vessby B, Unsitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, Nalsen C, Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB, Storlien LH: Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU study. Intake of dietary fiber is associated with lower all-cause mortality (128,129) in people with diabetes. (A), Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycemic control. Vitamins and Type 2 Diabetes Mellitus - PMC - National Center for If adiposity is a concern, medications that are weight neutral or weight reducing (e.g., metformin, incretin-based therapies, sodium glucose co-transporter 2 [SGLT-2] inhibitors) could be considered. Parker B, Noakes M, Luscombe N, Clifton P: Effect of a high-protein, highmonounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. (B). All authors supplied detailed input and approved the final version. W.S.Y. In the absence of clear scientific evidence for benefit in people with combined diabetes and hypertension (230,231), sodium intake goals that are significantly lower than 2,300 mg/day should be considered only on an individual basis. In terms of specific effects of fructose, concern has been raised regarding elevations in serum triglycerides (143,144). There is now abundant evidence from studies of individuals without diabetes that because of their high amounts of rapidly absorbable carbohydrates (such as sucrose or high-fructose corn syrup), large quantities of SSBs should be avoided to reduce the risk for weight gain and worsening of cardiometabolic risk factors (140142). There currently exists insufficient evidence of benefit from vitamin or mineral supplementation in people with or without diabetes in the absence of an underlying deficiency (3,193,194). Cefalu WT, Hu FB: Role of chromium in human health and in diabetes. Findings from randomized controlled trials (RCTs) and from systematic and Cochrane reviews demonstrate the effectiveness of nutrition therapy for improving glycemic control and various markers of cardiovascular and hypertension risk (13,14,2946). Other studies have shown a higher risk of thiamin deficiency in people with type 1 and/or type 2 diabetes based on tests of erythrocyte . Manning RM, Jung RT, Leese GP, Newton RW: The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: four-year follow-up. (B). Not all weight loss interventions reviewed led to improvements in A1C at 1 year (35,68,70,71,74,75), although these studies tended to achieve less weight loss. The food industry can play a major role in lowering sodium content of foods to help people meet sodium recommendations (233,234). Wasserman DH, Zinman B: Exercise in individuals with IDDM. Mozaffarian D, Bryson CL, Lemaitre RN, Burke GL, Siscovick DS: Fish intake and risk of incident heart failure. Althuis MD, Jordan NE, Ludington EA, Wittes JT: Glucose and insulin responses to dietary chromium supplements: a meta-analysis. Evidence from large prospective cohort studies, clinical trials, and a systematic review of RCTs indicate that high-MUFA diets are associated with improved glycemic control and improved CVD risk or risk factors (70,169171). (E). Vegetables - RDA 3 to 5 servings per day. Erkkila AT, Lichtenstein AH, Mozaffarian D, Herrington DM: Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease. Adults with diabetes choosing to consume alcohol should limit their intake to one serving or less per day for women and two servings or less per day for men (105). The meal planning approach or eating pattern should be selected based on the individuals personal and cultural preferences; literacy and numeracy; and readiness, willingness, and ability to change. A systematic review by Wheeler et al. Personal preferences (e.g., tradition, culture, religion, health beliefs and goals, economics) and metabolic goals should be considered when recommending one eating pattern over another. The blood pressure benefits are thought to be due to the total eating pattern, including the reduction in sodium and other foods and nutrients that have been shown to influence blood pressure (99,105). Fructose is a monosaccharide found naturally in fruits. 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. Fructose consumed as free fructose (i.e., naturally occurring in foods such as fruit) may result in better glycemic control compared with isocaloric intake of sucrose or starch (B), and free fructose is not likely to have detrimental effects on triglycerides as long as intake is not excessive (>12% energy). Including bread, cereal, rice, and pasta. The Role of Micronutrients in Managing Diabetes Liese AD, Roach AK, Sparks KC, Marquart L, DAgostino RB Jr, Mayer-Davis EJ: Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R: Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Diabetes - Diagnosis and treatment - Mayo Clinic Retrospective studies reveal durable A1C reductions with these types of programs (51,56) and significant improvements in quality of life (57) over time. Factors impacting eating patterns include, but are not limited to, food access/availability of healthful foods, tradition, cultural food systems, health beliefs, knowledge of foods that promote health and prevent disease, and economics/resources to buy health-promoting foods (95). In order to be effective, nutrition therapy should be individualized for each patient/client based on his or her individual health goals; personal and cultural preferences (241,242); health literacy and numeracy (243,244); access to healthful choices (245,246); and readiness, willingness, and ability to change. Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler L, Oneida B, Bovbjerg VE: Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. A.B.E. Despite the potential glycemic and cardiovascular benefits of moderate alcohol consumption, use may place people with diabetes at increased risk for delayed hypoglycemia. One of these studies included only individuals with newly diagnosed diabetes (72), and the other included predominantly individuals with diabetes early in the disease process (<30% were on insulin) (76). Unless otherwise noted, research reviewed was limited to those studies conducted in adults diagnosed with type 1 or type 2 diabetes. West SG, Hecker KD, Mustad VA, Nicholson S, Schoemer SL, Wagner P, Hinderliter AL, Ulbrecht J, Ruey P, Kris-Etherton PM: Acute effects of monounsaturated fatty acids with and without omega-3 fatty acids on vascular reactivity in individuals with type 2 diabetes. Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Raatz SK, Brinkley L, Chen YD, Grundy SM, Huet BA, et al. The ADA recognizes that education about glycemic index and glycemic load occurs during the development of individualized eating plans for people with diabetes. A meta-analysis on the effect of chromium picolinate on glucose and lipid profiles among patients with type 2 diabetes mellitus. Evidence is insufficient to support one specific amount of carbohydrate intake for all people with diabetes. Pomerleau J, Verdy M, Garrel DR, Nadeau MH: Effect of protein intake on glycaemic control and renal function in type 2 (non-insulin-dependent) diabetes mellitus. : research with AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Novo Nordisk, Merck, and Eli Lilly >$10,000, money goes to institution; consultant/advisory board with Janssen Phamaceuticals; other research support through the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute. Education and awareness regarding the recognition and management of delayed hypoglycemia is warranted. Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, Elgrably F, Slama G: Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial. Pijls LT, de Vries H, van Eijk JT, Donker AJ: Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Based on a review of the evidence, it is clear that gaps in the literature continue to exist and further research on nutrition and eating patterns is needed in individuals with type 1 and type 2 diabetes. PDF Energy Requirements for Older Patients with Type 2 Diabetes: A Kris-Etherton PM, Lichtenstein AH, Howard BV, Steinberg D, Witztum JL: Antioxidant vitamin supplements and cardiovascular disease. Therefore, collaborative goals should be developed with the individual with diabetes. People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public. An American Heart Association and ADA scientific statement on NNS consumption concludes that there is not enough evidence to determine whether NNS use actually leads to reduction in body weight or reduction in cardiometabolic risk factors (146). The following eating patterns (Table 3) were reviewed: Mediterranean, vegetarian, low fat, low carbohydrate, and DASH. Despite some improvements in cardiovascular risk factors, the Look AHEAD trial failed to demonstrate reduction in CVD events among individuals randomized to an intensive lifestyle intervention for sustained weight loss (77). Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, Hamman RF, Ackermann RT, Engelgau MM, Ratner RE: The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Once a thorough assessment is completed, the health care professionals role is to facilitate behavior change and achievement of metabolic goals while meeting the patients preferences, which may include allowing the patient to continue following his/her current eating pattern. They then advise which foods to focus on at which concentration, with the most regularly eaten food forming the wide base of the pyramid and those foods that should be eaten less regularly forming to top. Low levels of vitamin D is a prevalent issue in people across the globe. If the individual would like to try a different eating pattern, this should also be supported by the health care team. (B). No other potential conflicts of interest relevant to this article were reported. 1 Vitamin D treatment has also improved glycemic control and insulin sensitivity in people with type 1 diabetes, people with type 2 . Brand-Miller J, Hayne S, Petocz P, Colagiuri S: Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. In many of the reviewed studies, weight loss occurred, confounding the interpretation of results from manipulation of macronutrient content. Lonn E, Yusuf S, Hoogwerf B, Pogue J, Yi Q, Zinman B, Bosch J, Dagenais G, Mann JF, Gerstein HC: Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: results of the HOPE study and MICRO-HOPE substudy. Evidence indicates that the consumption of wholegrain cereals, vegetables, fruits, beans, nuts and dairy products, e.g. Whitworth JA, Chalmers J: World Health OrganisationInternational Society of Hypertension (WHO/ISH) hypertension guidelines. However, two trials reported no improvement in CVD risk factors (149,151). Health care professionals administering nutrition interventions in studies conducted outside the U.S. did not provide MNT as it is legally defined. CVD is a common cause of death among individuals with diabetes. But for many of our patients who have been self-medicating with supplements, it is not. The NHS provides the following diet advice for people with diabetes: [147] [148] Eat plenty of starchy carbohydrates with a low glycemic index (low GI) Increase the amount of fibre in your diet. : research with NIH and the Veterans Administration >$10,000, money goes to institution; spouse employee of ViiV Healthcare >$10,000. Tapsell LC, Gillen LJ, Patch CS, Batterham M, Owen A, Bare M, Kennedy M: Including walnuts in a low-fat/modified-fat diet improves HDL cholesteroltototal cholesterol ratios in patients with type 2 diabetes. Several intensive DSME and nutrition intervention studies show that glycemic control can be achieved while maintaining weight or even reducing weight when appropriate lifestyle counseling is provided (14,31,35,41,42,44,45,50,65,66). Salmeron J, Hu FB, Manson JE, Stampfer MJ, Colditz GA, Rimm EB, Willett WC: Dietary fat intake and risk of type 2 diabetes in women. Supplementation with flaxseed (32 g/day) or flaxseed oil (13 g/day) for 12 weeks did not affect glycemic control or adipokines (181). Previous studies using supplements had shown mixed effects on fasting blood glucose and A1C levels. recommended dietary allowance (RDA) the amount of nutrient and calorie intake per day considered necessary for maintenance of good health, calculated for males and females of various ages and recommended by the Food and Nutrition Board of the National Research Council. A weight loss of >6 kg (approximately a 78.5% loss of initial body weight), regular physical activity, and frequent contact with RDs appear important for consistent beneficial effects of weight loss interventions (85). Norris SL, Zhang X, Avenell A, Gregg E, Bowman B, Schmid CH, Lau J: Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: a review. This article reviews how micronutrient requirements are determined and summarizes current recommendations for supplementation and the most pertinent research on the use of key vitamins and minerals in diabetes management. Studies designed to reduce excess body weight have used a variety of energy-restricted eating patterns with various macronutrient intakes and occasionally included a physical activity component and ongoing follow-up support. Studies on gene-diet interactions will also be important, as well as studies on potential epigenetic effects that depend on nutrients to moderate gene expression. Nanchahal K, Ashton WD, Wood DA: Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women. The amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population. Which artificial sweetener should I choose. If used, patients should substitute them for comparable foods they eat in order to keep calories balanced and avoid weight gain (3,187). NHS approved education and behaviour change app for people with type 2 diabetes, prediabetes, obesity. (C). Raben A, Vasilaras TH, Moller AC, Astrup A: Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. A summary of key topics for nutrition education can be found in Table 4. Search for other works by this author on: Joshua J. Neumiller, PHARMD, CDE, CGP, FASCP, Standards of medical care in diabetes2013, European Association for the Study of Diabetes (EASD), Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association, The Diabetes Control and Complications Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, UK Prospective Diabetes Study (UKPDS) Group, Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34), Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, Modern-day clinical course of type 1 diabetes mellitus after 30 years duration: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications and Pittsburgh Epidemiology of Diabetes Complications Experience (1983-2005), 10-year follow-up of intensive glucose control in type 2 diabetes, Intensive glucose control and macrovascular outcomes in type 2 diabetes, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report, Cholesterol Treatment Trialists (CTT) Collaborators, Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis, The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults, Effectiveness of and adherence to dietary and lifestyle counselling: effect on metabolic control in type 2 diabetic Omani patients, Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Dose Adjustment For Normal Eating (DAFNE) randomised controlled trial, Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial, Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice, Deploying the chronic care model to implement and sustain diabetes self-management training programs, Achievement of goals in U.S. diabetes care, 1999-2010, Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study, Institute of Medicine. Philipp J Intern Med 2010;48:32-7. Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM: Effects of the National Cholesterol Education Programs Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. The recommendation for the general population to reduce sodium to less than 2,300 mg/day is also appropriate for people with diabetes. (A), o For individuals with type 1 diabetes, participation in an intensive flexible insulin therapy education program using the carbohydrate counting meal planning approach can result in improved glycemic control. As for the general U.S. population, carbohydrate intake from vegetables, fruits, whole grains, legumes, and milk should be encouraged over other sources of carbohydrates, or sources with added fats, sugars, or sodium, in order to improve overall nutrient intake (105). Intensive lifestyle programs (ongoing, with frequent follow-up) are required to achieve significant reductions in excess body weight and improvements in A1C, blood pressure, and lipids (76,83). RDA | definition of RDA by Medical dictionary CHAPTER 2. Clinical Nutrition Guideline for Overweight and Obese - AJMC Because uncontrolled diabetes is often associated with micronutrient deficiencies (195), people with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements from natural food sources and a balanced diet (3). It has been proposed that foods containing resistant starch or high amylose foods such as specially formulated cornstarch may modify postprandial glycemic response, prevent hypoglycemia, and reduce hyperglycemia. For individuals with type 1 diabetes using multiple daily injections or continuous subcutaneous insulin infusion, a primary focus for nutrition therapy should be on how to adjust insulin doses based on planned carbohydrate intake (13,39,43,5053). American Diabetes Association: Diabetes nutrition recommendations for health care institutions (Position Statement). Thiamin - Health Professional Fact Sheet - Office of Dietary Resistant starch is defined as starch physically enclosed within intact cell structures as in some legumes, starch granules as in raw potato, and retrograde amylose from plants modified by plant breeding to increase amylose content. Pittler MH, Stevinson C, Ernst E: Chromium picolinate for reducing body weight: meta-analysis of randomized trials. Other successful strategies included increasing physical activity, reducing portion sizes, using meal replacements (as appropriate), and encouraging individuals with diabetes to eat those foods with the greatest consensus for improving health. However, a study comparing diets with a high proportion of omega-3 (fatty fish) versus omega-6 (lean fish and fat-containing linoleic acid) fatty acids reported both diets had no detrimental effect on glucose measures, and both diets improved insulin sensitivity and lipoprotein profiles (185). In interventional studies lasting 12 months or longer and targeting individuals with type 2 diabetes to reduce excess body weight (35,6775), modest weight losses were achieved ranging from 1.9 to 8.4 kg. However, some of the studies also included caloric restriction, which may have contributed to improvements in glycemic control or blood lipids (100,108). Total energy intake (and thus portion sizes) is an important consideration no matter which eating pattern the individual with diabetes chooses to eat. (B). Therefore, it is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and support its implementation. This research should include multiple settings that can impact food choices for individuals with diabetes, such as where they live, work, learn, and play. (88) that many different approaches to nutrition therapy and eating patterns are effective for the target outcomes of improved glycemic control and reduced CVD risk among individuals with diabetes. Studies ranged in duration from 12 to 74 weeks, and the diets did not consistently improve glycemic control or CVD risk factors except when energy intake was restricted and weight was lost. Additionally, an IOM report suggests there is no evidence on health outcomes to treat certain population subgroupswhich includes individuals with diabetesdifferently than the general U.S. population (232). You can reduce waste buildup by controlling what you eat and drink. However, both MNT and nutrition therapy should involve a nutrition assessment, nutrition diagnosis, nutrition interventions (e.g., education and counseling), and nutrition monitoring and evaluation with ongoing follow-up to support long-term lifestyle changes, evaluate outcomes, and modify interventions as needed (20). Vitamin D and diabetes. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Another option for many people is referral to a comprehensive diabetes self-management education (DSME) program that includes instruction on nutrition therapy. LDL cholesterol <100 mg/dL; triglycerides <150 mg/dL; HDL cholesterol >40 mg/dL for men; HDL cholesterol >50 mg/dL for women. The IOM also defines nutrition therapy, which has a broader definition than MNT (19). WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Research has also compared the benefits of whole grains to fiber. The plan helps you control your blood sugar, also called blood glucose, manage your weight and control heart disease risk factors. Stevens J, Ahn K, Juhaeri, Houston D, Steffan L, Couper D: Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. A systematic review (212) evaluating the effects of cinnamon in people with diabetes concluded there is currently insufficient evidence to support its use, and there is a lack of compelling evidence for the use of other herbal products for the improvement of glycemic control in people with diabetes (213). In people with type 2 diabetes, a Mediterranean-style, monounsaturated fatty acid (MUFA)-rich eating pattern may benefit glycemic control and CVD risk factors and can, therefore, be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. Diabetes Food Pyramid

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