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DOI: 10.2337/dc08-S061
© 2008 by the American Diabetes Association
Position Statements |
Nutrition Recommendations and Interventions for Diabetes
A position statement of the American Diabetes Association
Abbreviations: 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
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INTRODUCTION |
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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.
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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
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GOALS OF MNT FOR PREVENTION AND TREATMENT OF DIABETES |
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Goals of MNT that apply to individuals at risk for diabetes or with pre-diabetes
Goals of MNT that apply to individuals with diabetes
Goals of MNT that apply to specific situations
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EFFECTIVENESS OF MNT |
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Recommendations
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ENERGY BALANCE, OVERWEIGHT, AND OBESITY |
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Recommendations
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NUTRITION RECOMMENDATIONS AND INTERVENTIONS FOR THE PREVENTION OF DIABETES (PRIMARY PREVENTION) |
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Recommendations
Diabetes in youth
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NUTRITION RECOMMENDATIONS FOR THE MANAGEMENT OF DIABETES (SECONDARY PREVENTION) |
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Carbohydrate in diabetes management
Recommendations
Amount and type of carbohydrate.
Fiber.
Sweeteners.
Resistant-starch/high-amylose foods.
Dietary fat and cholesterol in diabetes management
Recommendations
Protein in diabetes management
Recommendations
Optimal mix of macronutrients
Alcohol in diabetes management
Recommendations
Micronutrients in diabetes management
Recommendations
Antioxidants in diabetes management.
Chromium, other minerals, and herbs in diabetes management.
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NUTRITION INTERVENTIONS FOR SPECIFIC POPULATIONS |
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Nutrition interventions for type 1 diabetes
Recommendations
Nutrition interventions for type 2 diabetes
Recommendations
Nutrition interventions for pregnancy and lactation with diabetes
Recommendations
Nutrition interventions for older adults with diabetes
Recommendations
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NUTRITION RECOMMENDATIONS FOR CONTROLLING DIABETES COMPLICATIONS (TERTIARY PREVENTION) |
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Microvascular complications
Recommendations
Treatment and management of CVD risk
Recommendations
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NUTRITION INTERVENTIONS FOR ACUTE COMPLICATIONS AND SPECIAL CONSIDERATIONS FOR PATIENTS WITH COMORBIDITIES IN ACUTE AND CHONIC CARE FACILITIES |
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Hypoglycemia
Recommendations
Acute illness
Recommendations
Patients with diabetes in acute health care facilities
Recommendations
Patients with diabetes in long-term care facilities
Recommendations
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SUMMARY: NUTRITION RECOMMENDATIONS AND INTERVENTIONS FOR DIABETES— |
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