Evidence-based diabetes nutrition therapy recommendations are effective: the key is individualization

Marion J Franz, Jackie L Boucher, Alison B Evert, Marion J Franz, Jackie L Boucher, Alison B Evert

Abstract

Current nutrition therapy recommendations for the prevention and treatment of diabetes are based on a systematic review of evidence and answer important nutrition care questions. First, is diabetes nutrition therapy effective? Clinical trials as well as systematic and Cochrane reviews report a ~1%-2% lowering of hemoglobin A1c values as well as other beneficial outcomes from nutrition therapy interventions, depending on the type and duration of diabetes and level of glycemic control. Clinical trials also provide evidence for the effectiveness of nutrition therapy in the prevention of diabetes. Second, are weight loss interventions important and when are they beneficial? Modest weight loss is important for the prevention of type 2 diabetes and early in the disease process. However, as diabetes progresses, weight loss may or may not result in beneficial glycemic and cardiovascular outcomes. Third, are there ideal percentages of macronutrients and eating patterns that apply to all persons with diabetes? There is no ideal percentage of macronutrients and a variety of eating patterns has been shown to be effective for persons with diabetes. Treatment goals, personal preferences (eg, tradition, culture, religion, health beliefs, economics), and the individual's ability and willingness to make lifestyle changes must all be considered by clinicians and/or educators when counseling and educating individuals with diabetes. A healthy eating pattern emphasizing nutrient-dense foods in appropriate portion sizes, regular physical activity, and support are priorities for all individuals with diabetes. Reduced energy intake for persons with prediabetes or type 2 diabetes as well as matching insulin to planned carbohydrate intake are intervention to be considered. Fourth, is the question of how to implement nutrition therapy interventions in clinical practice. This requires nutrition care strategies.

Keywords: diabetes nutrition therapy; eating patterns; macronutrients; weight loss interventions.

References

    1. Academy of Nutrition and Dietetics Diabetes type 1 and 2 for adults evidence-based nutrition practice guidelines. 2008. [Accessed October 12, 2013]. Available from: .
    1. Franz MJ, Powers MA, Leontos C, et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc. 2010;110:1852–1889.
    1. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013;36:3821–3842.
    1. Pastors JG, Franz MJ. Effectiveness of medical nutrition therapy in diabetes. In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA, USA: American Diabetes Association; 2012.
    1. UK Prospective Diabetes Study (UKPDS) 7 Response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients. Metabolism. 1990;39:905–912.
    1. Andrews RC, Cooper AR, Montgomery AA, et al. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the early ACTID randomized controlled trial. Lancet. 2011;378:129–139.
    1. Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI. Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimized drug treatment – Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomized controlled trial. BMJ. 2010;341:c3337.
    1. DAFNE Study Group Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Dose Adjusted For Normal Eating (DAFNE) randomized controlled trial. BMJ. 2002;325:746–752.
    1. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in US diabetes care. 1999–2010. N Engl J Med. 2013;368:1613–1624.
    1. Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. 2008;31:655–660.
    1. Gary TL, Genkinger JM, Guallar E, Peyrot M, Brancati FL. Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Care. 2003;29:488–501.
    1. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159–1172.
    1. Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk Van JT, Assendelft WJ. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 2001;24:1821–1833.
    1. Deakin T, McShane CE, Cade JR, Williams RD. Group based training for self-management strategies in people with type 2 diabetes. Cochrane Database Syst Rev. 2005;2:CD003417.
    1. Youssef G. Nutrition therapy and prediabetes. In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA, USA: American Diabetes Association; 2012.
    1. Diabetes Prevention Program Research Group. Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677–1686.
    1. Feldstein AC, Nichols GA, Smith DH, et al. Weight change in diabetes and glycemic and blood pressure control. Diabetes Care. 2008;31:1960–1965.
    1. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151:306–314.
    1. Franz MJ. The obesity paradox and diabetes. Diabetes Spectr. 2013;26:145–151.
    1. Pi-Sunyer X, Blackburn G, Brancati FL, et al. Look AHEAD Research Group Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:145–154.
    1. Look AHEAD Research Group Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566–1575.
    1. Look AHEAD Research Group Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–154.
    1. Franz MJ, VanVormer JJ, Crain Al, et al. Weight loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year duration. J Am Diet Assoc. 2007;107:1755–1767.
    1. Warshaw HS. Nutrition therapy for adults with type 2 diabetes. In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA, USA: American Diabetes Association; 2012.
    1. Oza-Frank R, Cheng YJ, Narayan KM, Gregg EW. Trends in nutrient intake among adults with diabetes in the United States: 1988–2004. J Am Diet Assoc. 2009;109:1173–1178.
    1. Brand-Miller JC, Stockmann K, Atkinson F, Petocz P, Denyer G. Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: analysis of a database of more than 1000 foods. Am J Clin Nutr. 2009;89:97–105.
    1. Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups and eating patterns in the management of diabetes: a systematic review of the literature. 2010. Diabetes Care. 2012;35:434–445.
    1. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33:2477–2483.
    1. American Diabetes Association Standards of medical care in diabetes – 2013 (position statement) Diabetes Care. 2013;36(Suppl 1):S11–S66.
    1. Stanhope KL, Schwarz JM, Klein NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119:1322–1334.
    1. US Department of Agriculture . Nutritive and Nonnutritive Sweetener Resources. National Agricultural Library, Food and Nutrition Information Center; 2013. [Accessed October 24, 2013]. Available from: .
    1. Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Iraklianou S, Berdanier CD, Zampelas A. A high protein low fat meal does not influence glucose and insulin responses in obese individuals with or without type 2 diabetes. J Hum Nutr Diet. 2010;23:183–189.
    1. Bosch J, Gerstein HC, Dagenais GR, et al. n-3 Fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367:309–318.
    1. Estadella D, da Penha Oller do Nascimento CM, Oyama LM, Riberio EB, Damaso AR, de Piano A. Lipotoxicity: effects of dietary saturated and trans fatty acids. [Accessed October 24, 2013]. Available from: .
    1. Riserus U. Fatty acids and insulin sensitivity. Curr Opin Clin Nutr Metab Care. 2008;11:100–105.
    1. Lee JS, Pinnamaneni SK, Eo SJ, et al. Saturated, but not n-6 polyunsaturated fatty acids induce insulin resistance: role of intramuscular accumulation of lipid metabolites. J Appl Physiol. 2006;100:1467–1474.
    1. Rosenfalck AM, Almdal T, Viggers L, Madsbad S, Hilsted J. A low-fat diet improves peripheral insulin sensitivity in patients with type 1 diabetes. Diabet Med. 2006;23:384–392.
    1. Davis NJ, Tomuta N, Schechter C, et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care. 2009;32:1147–1152.
    1. Ahmed AT, Karter AJ, Warton M, Doan JU, Weisner CM. The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Registry. J Gen Intern Med. 2008;3:275–282.
    1. Howard AA, Amsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140:211–219.
    1. Koppes LL, Dekker JM, Hendriks HJ, Bouter LM, Heine RJ. Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients. Diabetologia. 2006;49:648–652.
    1. Bantle AE, Thomas W, Bantle JP. Metabolic effects of alcohol in the form of wine in persons with type 2 diabetes mellitus. Metabolism. 2008;57:241–245.
    1. Franz MJ. Alcohol and diabetes. In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA, USA: American Diabetes Association; 2012.
    1. Yeh GY, Eisenberg DM, Davis RB, Phillips RS. Use of complementary and alternative medicine among people with diabetes mellitus: results of a national survey. Am J Public Health. 2003;92:1648–1652.
    1. Neumiller JJ. Micronutrient and diabetes. In: Franz MJ, Evert AB, editors. American Diabetes Association Guide to Nutrition Therapy for Diabetes. Alexandria, VA, USA: American Diabetes Association; 2012.
    1. Suckling RJ, He FH, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010;12:CD006763.
    1. Maillot M, Drewnowski A. A conflict between nutritionally adequate diets and meeting the 2010 dietary guidelines for sodium. Am J Prev Med. 2012;42:174–179.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir