Nutritional Therapy for Adults with Diabetes or Prediabetes: ADA Consensus
There is no single approach or nutritional treatment for people with diabetes (any type) or prediabetes. There are different nutritional diet options for different people, and they depend on a number of variables and teamwork with healthcare professionals. Food is one of the essential pillars for the care of our health in general, and there is more talk about glycemic management.
Earlier this year the American Diabetes Association (ADA) published a Consensus on Nutrition Therapy, and presented the major findings at this year’s 79th Scientific Sessions. Although this information is aimed at healthcare professionals, we want to share some of the most interesting points so that, if necessary, you can discuss it with your team to choose the best plan for you.
- The specialist in charge: The ADA recommends that a registered dietitian or nutritionist is the best specialist to carry out any diet recommendations. It is suggested, of course, that these specialists are also certified diabetes educators, although it is not a mandatory certification.
- The objective: The objectives of any nutritional diet change must be personalized. Each will have different requirements for different nutrients. The evidence makes us see that there is no fixed and ideal percentage of nutrients for people with diabetes or prediabetes but that a plan should be created taking into account the requirements and also, the preferences of the person. One of the objectives in the development of any plan will naturally be the management or control of body weight, but glycemic management remains the highest priority.
- Considerations for carbohydrate intake: You have probably been told that the previous recommendation of the American Diabetes Association was 130g/day of carbohydrates in people with diabetes older than 19 years of age. Today we find other nutritional approaches, and in this consensus, the benefits of many of them are detailed. Once again, the importance of creating personalized plans is highlighted. These 130 grams in some people will be sufficient but in other populations may be reduced while others may be eliminated.
Different plans + diet options
|Food Plan||Benefits||Studies and publications that support this intervention|
Effects on A1c reduction
Effects on weight loss
|DIRECT Dietary Intervention Randomized Controlled Trial (DIRECT)|
|Vegan, Vegetarian||Reduction of blood glucose levels
Reduction of risks of development of Cardiovascular Diseases
Waist Circumference Reduction
Cholesterol Reduction, Triglycerides
Reduction of Blood Pressure.
|Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis|
|Low Fat||Weight reduction
There was no great improvement in glycemic management
|Look AHEAD (Action for Health in Diabetes) Trial|
Very Low Fat: Ornish or Pritikin
|Improvement in blood glucose levels
Improvement in blood pressure levels
Loss of cholesterol levels
|Long-term use of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise in the treatment of NIDDM patients|
|Low Carb and Very Low Carb Diets||A1C reduction
Lower blood pressure
|Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial|
|Dash Diet||Weight loss
Improvement in A1C only in one of the tests carried out
Lower blood pressure
Improvement in cholesterol levels
No difference in triglycerides
|Effects of the DASH diet and walking on blood pressure in patients with type 2 diabetes and uncontrolled hypertension: a randomized controlled trial|
|Paleo Diet||Different findings in A1C and weight loss as well as lipid loss||Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study|
|Intermittent Fasting||Weight loss
There was no significant improvement in A1C
Improvement in insulin sensitivity
|Intermittent fasting in type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial|
Use of Sweeteners + Alcohol Consumption
It is suggested to replace sugary drinks with sweeteners in things like tea instead. However, consumption should be limited. With alcohol, moderation is the secret: one drink a day for women and two or less for men. Diabetes education should be provided and must include extensive training on hypoglycemia, and the importance of blood glucose monitoring in cases of consuming alcoholic beverages.
This consensus also includes specific data for nutritional intervention in cases of complications such as gastroparesis. The American Diabetes Association places great emphasis, as do we, on teamwork and multidisciplinary management of all types of diabetes. A medical specialist should have the ability to refer you to a nutrition expert with whom you can work on customizing your meal plan.
This article is part of Beyond Type 2’s ADA 2019 coverage. For full ADA 2019 coverage, click here.