Personalize Diabetes Eating Plans, ADA Advises

Nicola M. Parry, DVM
April 23, 2019

A new consensus report on nutrition therapy from the American Diabetes Association (ADA) emphasizes the need for clinicians to customize eating plans for adults with diabetes or prediabetes.

"Though it might simplify messaging, a 'one-size-fits-all' eating plan is not evident for the prevention or management of diabetes, and it is an unrealistic expectation given the broad spectrum of people affected by diabetes and prediabetes, their cultural backgrounds, personal preferences, co-occurring conditions (often referred to as comorbidities), and socioeconomic settings in which they live," write Alison B. Evert, RD, from the University of Washington, Seattle, and colleagues.

The report, published April 18 in Diabetes Care, builds on the ADA's 2014 guidance on the nutritional management of diabetes.

However, there were not any specific research reports that drove the timing of this report, said corresponding author William S. Yancy Jr, MD, MHS, director, Duke University Diet and Fitness Center, Durham, North Carolina, in an interview with Medscape Medical News.

The consensus report, which mirrors guidance released last year from Diabetes UK, recognizes that nutritional strategies can be very effective for preventing and managing diabetes and its complications. Yancy also notes that the updated ADA recommendation now covers nutrition for people with prediabetes.

Overall, evidence indicates that multiple varied dietary strategies can be effective for managing diabetes, he emphasized. "This gives options to the patient and the practitioner, and means that practitioners should familiarize themselves with the various options in order to accommodate patients' unique needs to maximize success."

Eating patterns with evidence of their safety and effectiveness for diabetes management include very low carbohydrate, Mediterranean-style, low fat, and vegetarian plans, he continued.

"The statement also recognizes that dietary carbohydrate is the most important contributor to blood glucose," he said, "and that weight loss, when appropriate, is one of the most potent strategies for diabetes management."

Therefore, "nutritional therapies should be emphasized by practitioners for their important role in preventing and treating diabetes, either alone or in combination with medication," Yancy stressed.

Ideally, the person with diabetes or prediabetes should be centrally involved in developing an eating plan. And registered dietitian nutritionists can also play an integral role in the overall care of these patients, he added, because they are trained to provide nutritional counseling for diabetes.

For practitioners providing nutrition guidance to these patient populations, "key messages common among many dietary patterns are an emphasis on nonstarchy vegetables; minimizing added sugars (particularly sugary beverages) and refined grains; and choosing whole, unprocessed foods over processed foods," concluded Yancy.

Several authors have reported receiving consulting and/or speaking fees from the National Dairy Council and New England Dairy and Dairy Farmer; personal fees from Novo Nordisk, Merck, Amgen, Gilead, BOYDSense, American Medical Group Association, Janssen, and Sunstar Foundation; research support from the National Dairy Council, Kowa Company, and National Institutes of Health; grants from Sanofi, Pfizer, Merck, Novo Nordisk, Veterans Affairs, and the University of Michigan. One author has reported receiving an honorarium from the Academy of Nutrition and Dietetics and ADA outside the submitted work. Another author has reported being previously employed by the ADA. An author has reported a consulting relationship with

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SOURCE: Medscape, April 23, 2019. Diabetes Care. 2019;42:731-754.

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