The Role of Nutrition Therapy in the Management of Diabetes

In May of 2019, the American Diabetes Association released, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report. This report provides guidance supporting the need for individualized nutrition therapy for adults with prediabetes or Type 1 or Type 2 diabetes. It also recognizes the effectiveness of medical nutrition therapy provided by a registered dietitian nutritionist, which is outlined in the Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes.

According to the ADA consensus report, current evidence does not support a single ideal eating pattern for everyone with diabetes; the key to achieving optimal health and nutrition is individualization. A message reinforced by the Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Nutrition Intervention Evidence Reviews and Recommendations and the ADA's Standards of Care in Diabetes – 2023.

Research on a wide range of eating patterns has indicated that the focus at this time should be on the key factors that are common among them. For example, emphasizing non-starchy vegetables, minimizing sources of added sugars and refined grains, and choosing foods in their whole, unprocessed form over highly processed foods, as much as possible. In general, nutrition interventions should emphasize a variety of nutrient-dense foods in appropriate portion sizes as part of a healthful eating pattern.

Despite there being insufficient evidence to support a specific amount or percentage of calories from carbohydrate, protein or fats, many people believe a standard diet for diabetes exists. However, a variety of eating patterns are considered suitable for the management of diabetes, and the limiting of food choices is not indicated unless scientific evidence supports it. Therefore, an individualized eating plan is recommended and should take into account the patient or client's current pattern of eating, cultural and personal food preferences, and metabolic goals, as well as factors that affect meal planning, preparation and behavior change, including access to safe and nutritious food.

Evidence does indicate that a modest amount of weight loss (i.e., 7% to 10% of an individual's body weight) can reduce the risk for developing Type 2 diabetes for those with prediabetes. For individuals with Type 2 diabetes, weight loss of 3% to 7% can be beneficial with weight loss of 5% or more resulting in improvements in glycemia and other risk factors for cardiovascular disease. Weight loss greater than 10% has been associated with greater benefits and possible disease remission. As with diabetes, a variety of eating patterns are suitable for weight management.

Providing practical ways to sustain weight loss and behavior change is needed for individuals who are at risk for or diagnosed with diabetes. In order to be effective long-term, nutrition therapy will need to be re-evaluated and modified to accommodate any changes in life events and health, as they occur. Pharmacotherapy and metabolic surgery also may be considerations for some patients.

Another consistent topic throughout these professional resources is the unique role RDNs play in the provision of MNT in the prevention and treatment of diabetes. RDNs recognize the need to tailor nutrition interventions to the individual and are equipped to provide culturally sensitive care that reduces weight stigma and bias while taking into consideration co-morbidities and coordinating care with the health care team. To review the evidence regarding the effectiveness of MNT provided by RDNs and recommendations for the integration of MNT for adults with diabetes, prediabetes, and overweight or obesity, visit the Academy's Evidence Analysis Library.

References:

• Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. May 2019;42(5):731‐754. Accessed February 6, 2023.
• Early KB, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet. 2018;118(2):343-353.
• MacLeod J, Franz MJ, Handu D et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Nutrition Intervention Evidence Reviews and Recommendations. J Acad Nutr Diet. 2017;117(10):1637-1658.
• Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, et al. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes – 2023. Standards of Care in Diabetes. 2023;46(Suppl 1):S128-S139. Accessed February 6, 2023.
• Franz, MJ, MacLeod J, Evert A et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process, J Acad Nutr Diet. 2017;117(10):1659-1679.
• Morgan-Bathke M, Raynor HA, Baxter SD, et al. Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline. J Acad Nutr Diet. 123(3):520-545.