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Clinical Diabetes 20:53-64, 2002
© American Diabetes Association ®, Inc., 2002

Position Statement

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications

American Diabetes Association

This paper was peer-reviewed, modified, and approved by the American Diabetes Association Professional Practice Committee and the Executive Committee, October 2001. Printed with permission from Diabetes Care 25 (Suppl.1): S50–S60, 2002

Medical nutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Moreover, in clinical practice, nutrition recommendations that have little or no supporting evidence have been and are still being given to persons with diabetes. Accordingly, this position statement provides evidence-based principles and recommendations for diabetes medical nutrition therapy. The rationale for this position statement is discussed in the American Diabetes Association technical review "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications," which discusses in detail the published research for each principle and recommendation.1

Historically, nutrition recommendations for diabetes and related complications were based on scientific knowledge, clinical experience, and expert consensus; however, it was often difficult to discern the level of evidence used to construct the recommendations. To address this problem, the 2002 technical review1 and this position statement provide principles and recommendations classified according to the level of evidence available using the American Diabetes Association evidence grading system. However, the best available evidence must still take into account individual circumstances, preferences, and cultural and ethnic preferences, and the person with diabetes should be involved in the decision-making process. The goal of evidence-based recommendations is to improve diabetes care by increasing the awareness of clinicians and persons with diabetes about beneficial nutrition therapies.

Because of the complexity of nutrition issues, it is recommended that a registered dietitian, knowledgeable and skilled in implementing nutrition therapy into diabetes management and education, be the team member providing medical nutrition therapy. However, it is essential that all team members be knowledgeable about nutrition therapy and supportive of the person with diabetes who needs to make lifestyle changes.

GOALS OF MEDICAL NUTRITION THERAPY FOR DIABETES

Goals of medical nutrition therapy that apply to all persons with diabetes are as follows:

  1. Attain and maintain optimal metabolic outcomes including
    • Blood glucose levels in the normal range . . . [Full Text of this Article]

Goals of nutrition therapy that apply to specific situations include the following:
MEDICAL NUTRITION THERAPY FOR TYPE 1 AND TYPE 2 DIABETES

Carbohydrate and diabetes
RESISTANT STARCH

RECOMMENDATIONS

A-Level evidence
B-Level evidence
C-Level evidence
Expert consensus
PROTEIN AND DIABETES

RECOMMENDATIONS

B-Level evidence
Expert consensus
DIETARY FAT AND DIABETES

Fatty Acids and Dietary Cholesterol
Low fat diets
Fat replacements
RECOMMENDATIONS

A-Level evidence
B-Level evidence
C-Level evidence
ENERGY BALANCE AND OBESITY

RECOMMENDATIONS

A-Level evidence
MICRONUTRIENTS AND DIABETES

RECOMMENDATIONS

B-Level evidence
ALCOHOL AND DIABETES

RECOMMENDATIONS

B-Level evidence
SPECIAL CONSIDERATIONS FOR TYPE 1 DIABETES

SPECIAL CONSIDERATIONS FOR TYPE 2 DIABETES

MEDICAL NUTRITION THERAPY FOR SPECIAL POPULATIONS

Children and adolescents with diabetes
RECOMMENDATIONS

Expert consensus
PREGNANCY AND LACTATION WITH DIABETES

Pregnancy with prior-onset type 1 or type 2 diabetes
Gestational diabetes mellitus
Lactation
RECOMMENDATIONS

Expert opinion
OLDER ADULTS WITH DIABETES

RECOMMENDATIONS

A-Level evidence
Expert consensus
MEDICAL NUTRITION THERAPY FOR THE TREATMENT/PREVENTION OF ACUTE COMPLICATIONS OF DIABETES AND CO-MORBID CONDITIONS

Acute complications
RECOMMENDATIONS

A-Level evidence
B-Level evidence
Expert consensus
HYPERTENSION

RECOMMENDATIONS

A-Level evidence
Expert consensus
DYSLIPIDEMIA

RECOMMENDATIONS

B-Level evidence
Expert consensus
NEPHROPATHY

RECOMMENDATIONS

C-Level evidence
CATABOLIC ILLNESS

RECOMMENDATIONS

Expert consensus
DIABETES PREVENTION

RECOMMENDATIONS

A-Level evidence
B-Level evidence
SUMMARY

REFERENCES


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Copyright © 2002 by the American Diabetes Association.