Diabetes

P O S I T I O N

S T A T E M E N T

Nutrition Recommendations and Interventions for Diabetes
A position statement of the American Diabetes Association
AMERICAN DIABETES ASSOCIATION range or as close to normal as is safely possible important that all team members, including physicians and nurses, be knowledgeable about MNT and support its implementation. MNT, as illustrated in Table 1, playsa 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 obesity and includes MNT for individuals with prediabetes. Secondary and tertiary prevention interventions include MNT forindividuals with diabetes and seek to prevent (secondary) or control (tertiary) complications of diabetes. GOALS OF MNT FOR PREVENTION AND TREATMENT OF DIABETES Goals of MNT that apply to individuals at risk for diabetes or with pre-diabetes To decrease the risk of diabetes and cardiovascular disease (CVD) by promoting healthy food choices and physical activity leading to moderate weight loss that ismaintained. Goals of MNT that apply to individuals with diabetes 1) Achieve and maintain ● Blood glucose levels in the normal range or as close to normal as is safely possible ● A lipid and lipoprotein profile that reduces the risk for vascular disease ● Blood pressure levels in the normal 2) To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifyingnutrient intake and lifestyle 3) To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change 4) To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Goals of MNT that apply to specific situations 1) For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, andolder adults with diabetes, to meet the nutritional needs of these unique times in the life cycle. 2) For individuals treated with insulin or insulin secretagogues, to provide selfmanagement training for safe conduct of exercise, including the prevention and treatment of hypoglycemia, and diabetes treatment during acute illness. EFFECTIVENESS OF MNT Recommendations Individuals who have pre-diabetesor diabetes should receive individualized MNT; such therapy is best provided by a registered dietitian familiar with the components of diabetes MNT. (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)
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edical nutrition therapy (MNT) is important in preventingdiabetes, 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 previousposition 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 linkedto 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...