In January, the American Diabetes Association released new nutritional guidelines for the treatment and prevention of diabetes. The guidelines were published in the January 2002 issue of
Diabetes Care, a journal of clinical research.
Although many of the guidelines reflect information contained in previous position statements and technical reviews, there are some significant changes in the recommendations, including the following:
- The nutrition principles and recommendations are classified into four categories according to their levels of supporting evidence: those for which there is strong supporting evidence, some supporting evidence, or limited supporting evidence and those that are based on expert consensus.
- For the first time, the 2002 recommendations address how lifestyle approaches (weight management and physical activity) may prevent or delay the onset of diabetes.
The Role of Medical Nutrition Therapy in Diabetes
A position statement outlining the recommendations strongly supports the role of medical nutrition therapy (MNT)¹ in the management of diabetes. MNT encompasses not only the clinical principles of treatment but also takes into account an individual’s circumstances, cultural and ethnic preferences, and ability to realistically maintain lifestyle changes.
Two recent studies demonstrated the critical importance of glycemic control in preventing microvascular complications associated with diabetes. Both the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study relied on MNT to achieve treatment goals.
The technical review paper outlining the 2002 recommendations stresses that registered dietitians who are trained in diabetes management are the health professionals most qualified to provide MNT for people with diabetes. This review quotes multiple studies that have shown that MNT provided by registered dietitians is an effective way to reduce hemoglobin A1c levels and to improve dyslipidemia.
Nutrition Principles and Recommendations for People with Diabetes
In all, the guidelines provide 51 nutrition recommendations divided into 15 categories. A majority of the recommendations are for people with either type 1 or type 2 diabetes and deal with nutrient components of the diet such as carbohydrates, protein, fat, energy balance (including physical activity), micronutrients, and alcohol. Three of the recommendation categories address special populations: children and adolescents, women who are pregnant or lactating, and older adults. Other categories address clinical conditions such as acute complications, hypertension, dyslipidemia, nephropathy, and catabolic illness. The final category of recommendations addresses the prevention of diabetes.
Each recommendation has been assigned a grade (A, B, C, or E) according to the weight of the scientific evidence that supports it. An “A” rating means that there is supportive evidence from multiple, well-conducted studies; “B” is an intermediate rating signifying that there is some supporting evidence; “C” means that there is limited supporting evidence; “E” means that the recommendation is based on expert consensus.
A majority of the 2002 recommendations have received A, B, or E ratings, and only a few that have C ratings are included. For example, under recommendations about carbohydrate, an A rating was assigned to the recommendation that “foods containing carbohydrates from whole grain, fruits, vegetables, and low-fat milk are important components and should be included in a healthy diet,” because many well-controlled studies have shown this to be true. An E rating was given to the recommendation that “sucrose and sucrose-containing foods should be eaten in the context of a healthy diet,” because this is based on expert consensus. Other examples of the recommendations are included in Table 1.
For a complete listing of all the recommendations, please visit www.diabetes.org (For Health Professionals>Clinical Practice Recommendations>Position Statement>Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications) or call 1-800-342-2383 and request a copy of the guidelines.
¹ Medical nutrition therapy (MNT) replaces previously used terms such as diet, diet therapy, and dietary management.
