Highlights
Ann Albright, PhD, RD, ADA President-Elect of Health Care and Education and co-author, said in a news release: “When you’re talking about diabetes, there is no ‘one size fits all’ diet. For people with diabetes and those at risk for type 2 diabetes, medical nutrition therapy should be tailored to a person’s specific health issues and personal preferences to help maintain optimum health by controlling blood glucose levels, blood pressure, cholesterol and other risk factors. We hope these recommendations will help people make better choices about what they eat and how they live to maximize their chances of staying healthy.”
- A registered dietitian is the best person to provide nutrition counseling.
- General goals for obese patients who are at risk for type 2 diabetes or have type 2 diabetes include weight loss of 7% of body weight or more and at least 150 minutes per week of physical activity. Resistance training can improve glycaemia and may be encouraged 3 times per week. Fiber should be consumed at a minimum of 14 g/1000 kcal.
- While weight loss is a cornerstone of diabetes management and can improve insulin sensitivity, the optimal macronutrient content of a low-calorie diet has yet to be determined. Low carbohydrate diets that restrict total carbohydrate intake to less than 130 gm/ day are not recommended because of questionable long-term efficacy and possible deleterious effects on the lipid profile.
- While low-glycaemic diets and moderate alcohol consumption have been demonstrated to reduce the risk of developing type 2 diabetes, neither intervention is recommended for routine practice. Alcohol consumed alone does not acutely affect glucose or insulin concentrations and recommendations for alcohol intake among patients with diabetes are similar to those for the population at large.
- For patients with diabetes, carbohydrates should be primarily derived from fruits, vegetables, legumes and low-fat milk. Monitoring carbohydrate intake is vital to glycaemic control and monitoring consumption of foods with a low glycaemic index may promote modest improvements in glycaemic control vs total carbohydrate monitoring.
- Nonnutritive sweeteners do not appear to affect patient’s weight and may be used by patients with diabetes within the limits established by the US Food and Drug Administration.
- Saturated fat should be limited to less than 7% of total dietary intake among patients with diabetes. In addition, daily dietary cholesterol intake should be less than 200 mg. Patients should try to consume at least 2 servings of fish per week and consumption of 2 g/day of plant sterols and stanols may reduce total and low-density lipoprotein cholesterol levels.
- Among patients with diabetes and normal renal function, the authors suggest no change to the recommended daily dietary protein intake from that of the general population (15% to 20% of energy).
- Protein intake should be limited to 0.8 to 1.0 gm/kg of body weight per day among patients with diabetes and early chronic kidney disease, whereas patients with higher degrees of renal insufficiency should limit protein consumption to 0.8 mg/kg of body weight per day.
- Vitamin or mineral supplementation has not been clearly demonstrated to benefit individuals with diabetes compared with the general population.
- Hypoglycemia should ideally be treated with ingestion of 15 to 20 gm of glucose, although any carbohydrate containing glucose may be used. This treatment should be effective within 20 minutes, although plasma glucose should be tested again at 60 minutes because of the risk for recurrent hypoglycemia. Adding protein to the treatment of hypoglycemia does not improve the glycaemic response.
- Elderly patients with diabetes in long-term care facilities do not need to follow a strict diet for diabetes and may be offered a general diet. Caution should be exercised in recommending weight loss diets in this population.
- Bariatric surgery may only be considered for patients with type 2 diabetes and body mass index greater than 35 kg/m².