2008 American Diabetes Association Guidelines for Medical Nutrition Therapy

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2008 American Diabetes Association Guidelines for Medical Nutrition

Therapy

The American Diabetes Association (ADA) has updated its guidelines

regarding medical nutrition therapy (MNT), including the use of low-

carbohydrate diets to prevent diabetes, manage existing diabetes,

and prevent or slow the rate of development of diabetes

complications.

The revised position statement, which is published in the January

issue of Diabetes Care, updates those from 2002 and 2004, presenting

evidence-based data published since 2000 and grading of

recommendations according to the level of evidence available, based

on the ADA evidence-grading system.

P. Bantle, and colleagues from the ADA.write, " The goal of

these recommendations is to make people with diabetes and health

care providers aware of beneficial nutrition interventions. " " This

requires the use of the best available scientific evidence while

taking into account treatment goals, strategies to attain such

goals, and changes individuals with diabetes are willing and able to

make. Achieving nutrition-related goals requires a coordinated team

effort that includes the person with diabetes and involves him or

her in the decision-making process. "

In addition to listing major nutritional recommendations and

interventions for diabetes, the updated position statement stresses

the importance of monitoring metabolic parameters, including glucose

and glycated hemoglobin levels, lipids, blood pressure, body weight,

and renal function, during therapy. Such monitoring will help

evaluate the need for changes in MNT and thereby optimize outcomes.

The authors note that many aspects of MNT require additional

research.

Some of the specific recommendations include the following:

Individuals with prediabetes or diabetes should receive

individualized MNT, preferably administered by a registered

dietitian knowledgeable about the components of diabetes MNT (.

Nutrition counseling should be tailored to the personal needs of the

individual with prediabetes or diabetes and his or her willingness

and ability to make changes (E).

Modest weight loss in overweight and obese insulin-resistant

individuals has been shown to improve insulin resistance and is

therefore recommended for all such individuals who have or are at

risk for diabetes (A).

In the short-term (up to 1 year), either low-carbohydrate or low-

fat, energy-restricted diets may be effective for weight loss (A).

Patients receiving low-carbohydrate diets should undergo monitoring

of lipid profiles, renal function, and protein intake (in patients

with nephropathy), and have adjustment of hypoglycemic therapy as

needed (E).

Physical activity and behavior modification aid in weight loss and

are most helpful in maintaining weight loss (.

When combined with lifestyle modification, weight loss medications

may help achieve a 5% to 10% weight loss and may be considered for

overweight and obese individuals with type 2 diabetes (.

For some patients with type 2 diabetes and a body mass index of 35

kg/m2 or more, bariatric surgery can markedly improve glycemia (.

Primary prevention for individuals at high risk of developing type 2

diabetes should include structured programs targeting lifestyle

changes, with dietary strategies of decreasing energy and dietary

fat intakes. Goals should include moderate weight loss (7% body

weight), regular physical activity (150 minutes/week) (A), dietary

fiber intake of 14 g/1000 kcal, and whole grains comprising half of

total grain intake (.

Intake of low-glycemic index foods that are rich in fiber and other

vital nutrients should be encouraged (E), both for the general

population and for those with diabetes.

Data do not support recommending alcohol consumption to individuals

at risk for diabetes (.

Secondary prevention, or controlling diabetes, should include a

healthy dietary pattern emphasizing carbohydrate from fruits,

vegetables, whole grains, legumes, and low-fat milk (.

A key strategy for achieving glycemic control is to monitor

carbohydrate by counting, exchanges, or experienced-based estimation

(A). Use of glycemic index and load may be modestly beneficial vs

considering only total carbohydrate (.

Sucrose-containing foods should be limited but can be substituted

for other carbohydrates or covered with insulin or other glucose-

lowering medications (A). Glucose alcohols and nonnutritive

sweeteners are safe within daily US Food and Drug Administration

intake levels (A).

Saturated fat should be limited to less than 7% of total energy (A),

and trans fat should be minimized (E). In individuals with diabetes,

dietary cholesterol should not exceed 200 mg/day (E).

At least 2 servings of fish per week (except for commercially fried

fish) are recommended for n-3 polyunsaturated fatty acids (.

Protein should not be used to treat acute or prevent nighttime

hypoglycemia (A). High-protein diets are not recommended for weight

loss (E).

If adults with diabetes choose to use alcohol, intake should be

restricted to 1 drink per day or less for women and 2 drinks per day

or less for men (E) and consumed with food (E).

Practice Pearls

Previous research has suggested that MNT can reduce glycated

hemoglobin levels by approximately 1% for patients with type 1

diabetes and 1% to 2% for patients with type 2 diabetes.

The current guidelines do not recommend low-glycemic index or high-

protein diets for the routine treatment of patients with diabetes.

Moreover, most patients with diabetes should not routinely receive

supplements or vitamins.

The ADA has issued practice guidelines for screening, diagnostic,

and treatment interventions that are known or believed to improve

health outcomes of patients with diabetes. Each recommendation is

graded by the ADA as A, B, C, or E to indicate the level of

supporting evidence.

Diabetes Care. 2008;31(Suppl 1):S61-S78.

This article came from

http://www.diabetesincontrol.com/results.php?storyarticle=5405