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Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications

	INTRODUCTION

 
Medical nutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Moreover, in clinical practice, nutrition recommendations that have little or no supporting evidence have been and are still being given to persons with diabetes. Accordingly, this position statement provides evidence-based principles and recommendations for diabetes medical nutrition therapy. The rationale for this position statement is discussed in the American Diabetes Association technical review "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications," which discusses in detail the published research for each principle and recommendation (1).

Historically, nutrition recommendations for diabetes and related complications were based on scientific knowledge, clinical experience, and expert consensus; however, it was often difficult to discern the level of evidence used to construct the recommendations. To address this problem, the 2002 technical review (1) and this position statement provide principles and recommendations classified according to the level of evidence available using the American Diabetes Association evidence grading system. However, the best available evidence must still take into account individual circumstances, preferences, and cultural and ethnic preferences, and the person with diabetes should be involved in the decision-making process. The goal of evidence-based recommendations is to improve diabetes care by increasing the awareness of clinicians and persons with diabetes about beneficial nutrition therapies.

Because of the complexity of nutrition issues, it is recommended that a registered dietitian, knowledgeable and skilled in implementing nutrition therapy into diabetes management and education, be the team member providing medical nutrition therapy. However, it is essential that all team members be knowledgeable about nutrition therapy and supportive of the person with diabetes who needs to make lifestyle changes.

	GOALS OF MEDICAL NUTRITION THERAPY FOR DIABETES

 
Goals of medical nutrition therapy that apply to all persons with diabetes are as follows:
1. Attain and maintain optimal metabolic outcomes including

• Blood glucose levels . . . [Full Text of this Article]

	MEDICAL NUTRITION THERAPY FOR TYPE 1 AND TYPE 2 DIABETES

	RESISTANT STARCH

	RECOMMENDATIONS

	PROTEIN AND DIABETES

	RECOMMENDATIONS

	DIETARY FAT AND DIABETES

	RECOMMENDATIONS

	ENERGY BALANCE AND OBESITY

	RECOMMENDATIONS

	MICRONUTRIENTS AND DIABETES

	RECOMMENDATIONS

	ALCOHOL AND DIABETES

	RECOMMENDATIONS

	SPECIAL CONSIDERATIONS FOR TYPE 1 DIABETES

	SPECIAL CONSIDERATIONS FOR TYPE 2 DIABETES

	MEDICAL NUTRITION THERAPY FOR SPECIAL POPULATIONS

	RECOMMENDATIONS

	PREGNANCY AND LACTATION WITH DIABETES

	RECOMMENDATIONS

	OLDER ADULTS WITH DIABETES

	RECOMMENDATIONS

	MEDICAL NUTRITION THERAPY FOR THE TREATMENT/PREVENTION OF ACUTE COMPLICATIONS OF DIABETES AND CO-MORBID CONDITIONS

	RECOMMENDATIONS

	HYPERTENSION

	RECOMMENDATIONS

	DYSLIPIDEMIA

	RECOMMENDATIONS

	NEPHROPATHY

	RECOMMENDATIONS

	CATABOLIC ILLNESS

	RECOMMENDATIONS

	DIABETES PREVENTION

	RECOMMENDATIONS

	SUMMARY

	Footnotes

	References

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