Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]
Overview
The American Diabetes Association recommends for individualized dietary therapy for the patients with diabetes. Monitoring of carbohydrate in the diet can be done through carbohydrate counting, exchanges, experienced-based estimation and glycemic index. Saturated fat should be limited to <7% of total calories intake. In patients with diabetes and normal renal function the protein intake can be kept as 15% to 20% of total energy intake.
American Diabetes Association - General Nutrition Recommendations (DO NOT EDIT) [1]
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Effectiveness of MNT (medical nutrional therapy)
- Individuals who have pre-diabetes or diabetes should receive individualized MNT; such therapy is best provided by a RD (registered dietitian) familiar with the components of diabetes MNT (medical nutrional therapy). (B)
- Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. (E)
Energy Balance, Overweight, and Obesity
- For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)
Nutrition Recommendations for the Management of Diabetes (Secondary Prevention)
Carbohydrate in Diabetes Management
- A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. (B)
- Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation, remains a key strategy in achieving glycemic control. (A)
- The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. (B)
- Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake. (A)
- As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. However, evidence is lacking to recommend a higher fiber intake for people with diabetes than for the population as a whole. (B)
- Sugar alcohols and non-nutritive sweeteners are safe when consumed within the daily intake levels established by the FDA. (A)
Dietary Fat and Cholesterol in Diabetes Management
- Limit saturated fat to <7% of total calories. (A)
- Intake of trans fat should be minimized. (E)
- In individuals with diabetes, limit dietary cholesterol to <200 mg/day. (E)
- Two or more servings of fish per week (with the exception of commercially fried fish filets) provide n-3 polyunsaturated fatty acids and are recommended. (B)
Protein in Diabetes Management
- For individuals with diabetes and normal renal function, there is insufficient evidence to suggest that usual protein intake (15% to 20% of energy) should be modified. (E)
- In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations. Therefore, protein should not be used to treat acute or prevent nighttime hypoglycemia. (A)
- High-protein diets are not recommended as a method for weight loss at this time. The long-term effects of protein intake >20% of calories on diabetes management and its complications are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown. (E)
Alcohol in Diabetes Management
- If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for women and two drinks per day or less for men). (E)
- To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. (E)
- In individuals with diabetes, moderate alcohol consumption (when ingested alone) has no acute effect on glucose and insulin concentrations but carbohydrate co-ingested with alcohol (as in a mixed drink) may raise blood glucose. (B)
Micronutrients in Diabetes Management
- There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes (compared with the general population) who do not have underlying deficiencies. (A)
- Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. (A)
- Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore cannot be recommended.
Nutrition Interventions for Older Adults with Diabetes
- Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight. (E)
- A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. (C)
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References