Nutrition Recommendations and Interventions for Diabetes

A position statement of the American Diabetes Association

• CHD, coronary heart disease
• CKD, chronic kidney disease
• CVD, cardiovascular disease
• DPP, Diabetes Prevention Program
• FDA, Food and Drug Administration
• GDM, gestational diabetes mellitus
• MNT, medical nutrition therapy
• RDA, recommended dietary allowance
• USDA, U.S. Department of Agriculture

Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention (see Table 1). MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes MNT. The previous position statement with accompanying technical review was published in 2002 (1) and modified slightly in 2004 (2). This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available based on the American Diabetes Association evidence-grading system. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT.

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. It is recommended that a registered dietitian, knowledgeable and skilled in MNT, be the team member who plays the leading role in providing nutrition care. However, it is important that all team members, including physicians and nurses, be knowledgeable about MNT and support its implementation.

MNT, as illustrated in Table 1, plays a role in all three levels of diabetes-related prevention targeted by the U.S. Department of Health and Human Services. Primary prevention interventions seek to delay or halt the development of diabetes. This involves public health measures to reduce the prevalence of …