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Î Because diabetes nutrition therapy can result in cost savings (B) and
improved outcomes such as reduction in A1c (A), nutrition therapy
should be adequately reimbursed by insurance and other payers. (E)
Energy Balance, Overweight, and Obesity
Î For overweight or obese adults with type 2 diabetes or at risk for
diabetes, reducing energy intake while maintaining a healthful eating
pattern is recommended to promote weight loss. (A)
Î Modest weight loss may provide clinical benefits (improved glycemia,
blood pressure, and/or lipids) in some individuals with diabetes,
especially those early in the disease process. To achieve modest
weight loss, intensive lifestyle interventions (counseling about
nutrition therapy, physical activity, and behavior change) with ongoing
support are recommended. (A)
Eating Patterns and Macronutrient Distribution
Î Evidence suggests that there is not an ideal percentage of calories
from carbohydrate, protein, and fat for all people with diabetes
(B); therefore, macronutrient distribution should be based on
individualized assessment of current eating patterns, preferences,
and metabolic goals. (E)
Î A variety of eating patterns (combinations of different foods or food
groups) are acceptable for the management of diabetes. Personal
preference (eg, tradition, culture, religion, health beliefs and
goals, economics) and metabolic goals should be considered when
recommending one eating pattern over another. (E)
Carbohydrate Amount and Quality
Î Monitoring carbohydrate intake, whether by carbohydrate counting
or experience-based estimation, remains a key strategy in achieving
glycemic control. (B)
Î For good health, carbohydrate intake from vegetables, fruits, whole
grains, legumes, and dairy products should be advised over intake
from other carbohydrate sources, especially those that contain added
fats, sugars, or sodium. (B)
Î Substituting low-glycemic load foods for higher-glycemic load foods
may modestly improve glycemic control. (C)
Î People with diabetes should consume at least the amount of fiber and
whole grains recommended for the general public. (C)
Î While substituting sucrose-containing foods for isocaloric amounts of
other carbohydrates may have similar BG effects, consumption should
be minimized to avoid displacing nutrient-dense food choices. (A)
