Perspectives on Diabetes Care

Nutritional Recommendations are key!

Dec 3, 2013, 01:00 AM

I was recently catching up on some information and was intrigued by a New England Journal of Medicine editorial entitled, “Training Physicians to Manage Obesity – Back to the Drawing Board.” Even though I am not a medical physician, I agree with Colbert and Jangi regarding the necessary steps to have physicians recognize and address obesity. 

Shortly after reading this, I received an email regarding the government’s “soon-to-be” ban on trans fats.  As a diabetes educator, obesity is the problem that is either discussed or avoided during a patient appointment.   All of us have discussed physical activity with our patients, but we know the main problem is dietary habits.  As Americans, our diet is advertised as “super-sized” or “all-you-can-eat” portions. 

Recently, Diabetes Care published updated recommendations for nutrition therapy in the management of diabetes mellitus among adults.  There are 40 separate recommendations under 20 different categories.  For any diabetes educator, it is important to incorporate the highest level of evidence into clinical practice.  Here is a summary of those recommendations with the highest ratings:

• For any patient with diabetes – either type 1 or type 2, nutrition therapy is warranted as a component of the treatment plan.
• Individualized medical nutrition therapy should have achievable treatment goals.
• Carbohydrate counting and meal planning should be incorporated in the education program for a patient with type 1 diabetes.
• Nutrition therapy can help reduce the hemoglobin A1c level.
• Reduction in energy intake is important for patients with type 2 diabetes who are overweight or obese.
• A modest weight loss of 5 percent will improve blood pressure, cholesterol concentrations and glucose levels.
• The carbohydrate-to-insulin ratio is important and should be considered when developing and/or promoting eating patterns.
• The substitution of isocaloric carbohydrates should be minimized.
• The amount of dietary problem should not be limited below the usual intake for a patient with diabetes and kidney disease.
• For cardiovascular prevention and/or treatment, omega-3 fatty acid supplements should not be used among patients with diabetes.
• There is a lack of efficacy for antioxidant supplementation and long-term safety is unknown; therefore, these agents should not be recommended.

While I gave an overview, any diabetes educator can review the 22-page publication on nutrition therapy for diabetes management. 

Bon appétit!