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As is recommended for the general public, an increase in foods containing the long-chain omega-3 fatty acids EPA and docosahexaenoic acid (DHA), such as are found in fatty fish, is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies (302,303). In addition to diabetes MNT, DSMES is important for people with diabetes to improve cardiometabolic and microvascular outcomes in a disease that is largely self-managed (1,1923). Two meta-analyses of controlled trials (98,99) concluded that vegetarian and vegan eating plans can reduce A1C by an average of 0.30.4% in people with type 2 diabetes, and the larger meta-analysis (99) also reported that plant-based eating patterns reduced weight (weight reduction of 2 kg), waist circumference, LDL cholesterol (LDL-C), and nonHDL-C with no significant effect on fasting insulin, HDL-C, triglycerides, and blood pressure. The body makes enough cholesterol for physiological and structural functions such that people do not need to obtain cholesterol through foods. One of the most common causes is diabetes. Nutrition therapy for children with diabetes or women with gestational diabetes mellitus is not addressed in this review but is covered in other ADA publications, specifically Standards of Medical Care in Diabetes (5,6). There is no specific treatment for this form of diabetes insipidus other than lowering the amount of fluids you drink. However, such very high intake of fiber may cause flatulence, bloating, and diarrhea. Find healthy eating tips that can help you manage diabetes and get the nutrition you need during cancer treatment. Other meta-analyses focusing on nonmedicine or medicine-assisted weight loss interventions in type 2 diabetes support this finding (143145). To support weight loss and improve A1C, CVD risk factors, and quality of life in adults with overweight/obesity and prediabetes or diabetes, MNT and DSMES services should include an individualized eating plan in a format that results in an energy deficit in combination with enhanced physical activity. reports a consulting relationship with dietdoctor.com, which began after the Consensus Report was submitted to Diabetes Care. MNT: cost effectiveness, cost-benefit, or economic savings of MNT (2009) [Internet]. Sugar gets into the cells with the help of a hormone called insulin. Results from a randomized cross-over study, Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial, A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study, Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial, Dietary Intervention Randomized Controlled Trial (DIRECT) Group, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts, A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes, Toward improved management of NIDDM: a randomized, controlled, pilot intervention using a lowfat, vegetarian diet, Type of vegetarian diet, body weight, and prevalence of type 2 diabetes, Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes, A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial, Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial, Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis, Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial, One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes, Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes, In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss, A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes, Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis, Long-term use of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise in the treatment of NIDDM patients, Diet and exercise in the treatment of NIDDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. Diabetol Metab Syndr 2016;8:28, Management of severe insulin resistance in patients with type 1 diabetes, The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study, Obesity and coronary artery calcium in diabetes: the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study, Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes, Obesity and type 1 diabetes mellitus management, Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association, Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON), Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms, Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance, Intensive multidisciplinary weight management in patients with type 1 diabetes and obesity: a one-year retrospective matched cohort study, Weight management in patients with type 1 diabetes and obesity, Sotagliflozin in combination with optimized insulin therapy in adults with type 1 diabetes: the North American inTandem1 Study, Dapagliflozin as additional treatment to liraglutide and insulin in patients with type 1 diabetes, The effect of metabolic surgery on type 1 diabetes: meta-analysis, Bariatric surgery in obese patients with type 1 diabetes, Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: results from a cross-sectional study in primary and secondary care settings, Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification, Eating disorders in adolescents with type 1 diabetes: challenges in diagnosis and treatment, Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients. Available from, Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Diabetes Care, Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial, The effect of medical nutrition therapy by a registered dietitian nutritionist in patients with prediabetes participating in a randomized controlled clinical research trial, Imbedding interdisciplinary diabetes group visits into a community-based medical setting, Dietitian-coached management in combination with annual endocrinologist follow up improves global metabolic and cardiovascular health in diabetic participants after 24 months, 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, A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes, Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? The goal is to achieve and maintain normal blood glucose levels as safely as possible. A few studies have shown modest A1C reduction (0.2% to 0.3%) (53,54) with intake in excess of 50 g of fiber per day. For this reason, nutrition therapy to support a 710% weight loss is the appropriate goal in treating people with prediabetes, unless additional weight loss is desired for other purposes. The addition of metabolic surgery (148), weight loss medications (149), and glucose-lowering agents that promote weight loss (150) can also be used as an adjunct to lifestyle interventions, resulting in greater weight loss that is maintained for a longer period of time. Currently, use of nutrition counseling approaches aimed at personalizing guidance based on genetic, metabolomic, and microbiome information is an area of intense research. 2019 by the American Diabetes Association. it is also refreshingly specific, making it a handy tool for. Do you know your blood pressure? For more information on fat intake and CVD risk, see the section role of nutrition therapy in the prevention and management of diabetes complications (cvd, diabetic kidney disease, and gastroparesis). Though evidence-based, the recommendations presented are the informed, expert opinions of the authors after consensus was reached through presentation and discussion of the evidence. The recommendation for the general public to eat a serving of fish (particularly fatty fish) at least two times per week is also appropriate for people with diabetes. One randomized crossover trial with 10 participants examined a VLC eating pattern aiming for 47 g carbohydrate per day without a focus on calorie restriction compared with a higher carbohydrate eating pattern aiming for 225 g carbohydrate per day for 1 week each. This article is featured in a podcast available at http://www.diabetesjournals.org/content/diabetes-core-update-podcasts. Future studies should address. One of the studies (127) showed similar reductions in A1C, weight, and medication doses when 2 days of severe energy restriction were compared with chronic energy restriction. Available from, Relevance of the glycemic index and glycemic load for body weight, diabetes, and cardiovascular disease, Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus, Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus, Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial, Dietary fiber for the treatment of type 2 diabetes mellitus: a meta-analysis, Position of the Academy of Nutrition and Dietetics: health implications of dietary fiber, Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: analysis of a database of more than 1,000 foods, Effect of a chicken-based diet on renal function and lipid profile in patients with type 2 diabetes: a randomized crossover trial, The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) studya 3-mo randomized controlled trial, Dietary tartary buckwheat intake attenuates insulin resistance and improves lipid profiles in patients with type 2 diabetes: a randomized controlled trial, Salba-chia (Salvia hispanica L.) in the treatment of overweight and obese patients with type 2 diabetes: a double-blind randomized controlled trial, Feasibility and efficacy of an isocaloric high-protein vs. standard diet on insulin requirement, body weight and metabolic parameters in patients with type 2 diabetes on insulin therapy, Effects of high-protein diets on body weight, glycaemic control, blood lipids and blood pressure in type 2 diabetes: meta-analysis of randomised controlled trials, Metabolic effects of monounsaturated fatty acidenriched diets compared with carbohydrate or polyunsaturated fatty acidenriched diets in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials, Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies, Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis, Dietary cholesterol, heart disease risk and cognitive dissonance, Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Fatty Acids and Outcomes Research Consortium (FORCE), Omega-6 fatty acid biomarkers and incident type 2 diabetes: pooled analysis of individual-level data for 39740 adults from 20 prospective cohort studies, Effects of 6-month eicosapentaenoic acid treatment on postprandial hyperglycemia, hyperlipidemia, insulin secretion ability, and concomitant endothelial dysfunction among newly-diagnosed impaired glucose metabolism patients with coronary artery disease. Sugar alcohols represent a separate category of sweeteners. The roles of differing macronutrient percentages, eating patterns and weight loss interventions are controversial. A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes. Consuming alcohol with food can minimize the risk of nocturnal hypoglycemia (227,228). Reduced caloric intake to achieve and maintain a healthier body weight should be a . Using insulin; Diabetic Gastroparesis; Diuretics; Diuretics: A cause of low potassium? We found limited evidence about the safety and/or effects of fasting on type 1 diabetes (129). Background: Diabetes nutrition therapy provided for individuals with diabetes must be based on research documenting effectiveness. Diabetes MNT is a covered Medicare benefit and should also be adequately reimbursed by insurance and other payers, or bundled in evolving value-based care and payment models, because it can result in improved outcomes such as reduced A1C and cost savings (12,17,25). The National Academy of Medicine (formerly the Institute of Medicine) broadly defines nutrition therapy as the treatment of a disease or condition through the modification of nutrient or whole-food intake ().To complement diabetes nutrition therapy, members of the health care team can and should provide evidence-based guidance that allows . A 12-week study comparing 30% vs. 15% energy from protein noted improvements in weight, fasting glucose, and insulin requirements in the group that consumed 30% energy from protein (61). Systematic review and meta-analysis of the efficacy of interventions for people with type 1 diabetes mellitus and disordered eating, Disordered eating behaviors in emerging adults with type 1 diabetes: a common problem for both men and women, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Sugar sweetened beverages and cardiometabolic health, Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us, Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction, Plain-water intake and risk of type 2 diabetes in young and middle-aged women, Food & Nutrition Information Center, National Agricultural Library, U.S. Department of Agriculture. What physical activities should I do if I have diabetes? Whereas no single eating pattern has emerged as being clearly superior to all others for all diabetes-related outcomes, evidence suggests certain eating patterns are better for specific outcomes. While reducing sodium to the general recommendation of <2,300 mg/day demonstrates beneficial effects on blood pressure (118), further reduction warrants caution. Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. In type 2 diabetes, 5% weight loss is recommended to achieve clinical benefit, and the benefits are progressive. The intervention in the PREvencin con DIeta MEDiterrnea (PREDIMED) study, comparing a Mediterranean-style eating pattern supplemented either with extra-virgin olive oil or with nuts versus a control diet, reduced incidence of type 2 diabetes among people without diabetes at high cardiovascular risk at baseline (69). Available from, Effects of alcohol on plasma glucose and prevention of alcohol-induced hypoglycemia in type 1 diabetesa systematic review with GRADE, Alcohol health literacy in young adults with type 1 diabetes and its impact on diabetes management, Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis, Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients, Alcohol consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies, Specific types of alcoholic beverage consumption and risk of type 2 diabetes: a systematic review and meta-analysis, Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association, Multivitamins in the prevention of cardiovascular disease in men: the Physicians Health Study II randomized controlled trial, Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials, Micronutrient status in diabetes mellitus, Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications, Effect of chromium supplementation on glucose metabolism and lipids: a systematic review of randomized controlled trials, A dietary supplement containing cinnamon, chromium and carnosine decreases fasting plasma glucose and increases lean mass in overweight or obese pre-diabetic subjects: a randomized, placebo-controlled trial, Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial, Oral magnesium supplementation in insulin-requiring type 2 diabetic patients, Supplementation with cholecalciferol does not improve glycaemic control in diabetic subjects with normal serum 25-hydroxyvitamin D levels, Lack of effect of subtherapeutic vitamin D treatment on glycemic and lipid parameters in type 2 diabetes: a pilot prospective randomized trial, Pilot study to evaluate the effect of short-term improvement in vitamin D status on glucose tolerance in patients with type 2 diabetes mellitus, Daily consumption of vitamin D or vitamin D + calciumfortified yogurt drink improved glycemic control in patients with type 2 diabetes: a randomized clinical trial, Effect of daily vitamin D supplementation on HbA1c in patients with uncontrolled type 2 diabetes mellitus: a pilot study, Vitamin D supplementation in patients with diabetes mellitus type 2 on different therapeutic regimens: a one-year prospective study, Vitamin D supplementation has no effect on insulin sensitivity or secretion in vitamin D-deficient, overweight or obese adults: a randomized placebo-controlled trial, Effect of vitamin D supplementation on oral glucose tolerance in individuals with low vitamin D status and increased risk for developing type 2 diabetes (EVIDENCE): a double-blind, randomized, placebo-controlled clinical trial, Adequate vitamin D status is associated with the reduced odds of prevalent diabetic retinopathy in African Americans and Caucasians, Effects of calcium-vitamin D co-supplementation on metabolic profiles in vitamin D insufficient people with type 2 diabetes: a randomised controlled clinical trial, Effect of magnesium supplementation on glucose metabolism in people with or at risk of diabetes: a systematic review and meta-analysis of double-blind randomized controlled trials, U.S. Food and Drug Administration. Strategies to improve access, clinical outcomes, and cost effectiveness include the following. Several large type 2 diabetes prevention RCTs (26,74,83,84) used low-fat eating plans to achieve weight loss and improve glucose tolerance, and some demonstrated decreased incidence of diabetes (26,74,83). In general, replacing saturated fat with unsaturated fats, especially polyunsaturated fat, significantly reduces both total cholesterol and LDL-C, and replacement with monounsaturated fat from plant sources, such as olive oil and nuts, reduces CVD risk. ; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; Stroke Council. All eating patterns include a range of more-healthy versus less-healthy options: lentils and sugar-sweetened beverages are both considered part of a vegan eating pattern; fish and processed red meats are both considered part of a low-carbohydrate eating pattern; and removing the bun from a fast food burger might make it part of a paleo eating pattern but does not necessarily make it healthier. More research is needed in this area. Health care providers should ask about the use of supplements and herbal products, and providers and people with or at risk for diabetes should discuss the potential benefit of these products weighed against the cost and possible adverse effects and drug interactions. The replacement of saturated fat with monounsaturated or polyunsaturated fat in food or replacement of trans fat with monounsaturated fat in food was inversely associated with CVD (299). Replace sugar-sweetened beverages (SSBs) with water as often as possible. Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Cost-effectiveness of lifestyle interventions and MNT for the prevention and management of diabetes has been documented in multiple studies (12,17,24,25). In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners. In a single-blinded RCT design in Asia, 107 subjects with newly diagnosed impaired glucose metabolism and coronary heart disease (CHD) supplemented with 1,800 mg/day of eicosapentaenoic acid (EPA) experienced improved postprandial triglycerides, glycemia, insulin secretion ability, and endothelial function over a 6-month period (68). Other meta-analyses of observational studies have not shown an inverse relationship with full-fat dairy intake and diabetes risk (72,73). The routine use of chromium or vitamin D micronutrient supplements or any herbal supplements, including cinnamon, curcumin, or aloe vera, for improving glycemia in people with diabetes is not supported by evidence and is therefore not recommended. For people following a vegetarian or vegan eating pattern, omega-3 -linoleic acid (ALA) found in plant foods such as flax, walnuts, and soy are reasonable replacements for foods high in saturated fat and may provide some CVD benefits, though the evidence is inconclusive. role of nutrition therapy in the prevention and management of diabetes complications (cvd, diabetic kidney disease, and gastroparesis). Published intermittent fasting studies involving diabetes and diabetes prevention demonstrate a variety of approaches, including restricting food intake for 18 to 20 h per day, alternate-day fasting, and severe calorie restriction for up to 8 consecutive days or longer (123). Unless otherwise noted, the research reviewed was limited to those studies conducted in adults diagnosed with prediabetes, type 1 diabetes, and/or type 2 diabetes. within individualized treatment goals is recommended for all adults with diabetes and prediabetes. Diabetes-focused MNT is provided by a registered dietitian nutritionist/registered dietitian (RDN), preferably one who has comprehensive knowledge and experience in diabetes care. An outside market research company was used to conduct the literature search and was paid using ADA funds. People with diabetes and prediabetes should be screened and evaluated during DSMES and MNT encounters for disordered eating, and nutrition therapy should accommodate these disorders.

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