Table 3. Comprehensive Diabetes Care Treatment Goals (cont'd) Parameter
Treatment Goal
Weight Weight loss
Anticoagulant Therapy Aspirin
Reduce weight by at least 5%-10%; avoid weight gain
For secondary CVD prevention or primary prevention for patients at very high riska
a High risk = DM without CVD; highest risk = DM plus CVD
Table 4. Blood Pressure Goals and Treatment Systolic mmHg Diastolic mmHg Treatment < 130
< 80
130-139 ≥ 140
Topic
General eating habits
80-89 ≥ 90
Recommendation
> Regular meals and snacks; avoid fasting to lose weight > Plant-based diet (high in fiber, low calories/glycemic index, and high in phytochemicals/antioxidants)
> Understand Nutrition Facts Label information > Incorporate beliefs and culture into discussions > Informal physician-patient discussions > Use mild cooking techniques instead of high-heat cooking
Carbohydrate > Explain the 3 types of carbohydrates: sugars, starch, and fiber and the effects on health for each type
> Specify healthful carbohydrates (fresh fruits and vegetables, pulses, whole grains); target 7-10 servings per day
> Lower-glycemic index foods may facilitate glycemic control (glycemic index score < 55 out of 100: multigrain bread, pumpernickel bread, whole oats, legumes, apple, lentils, chickpeas, mango, yams, brown rice), but there is insufficient evidence to support a formal recommendation to educate patients that sugars have both positive and negative health effects
Fat Protein
> Specify healthful fats (low mercury/contaminant-containing nuts, avocado, certain plant oils, fish)
> Limit saturated fats (butter, fatty red meats, tropical plant oils, fast foods) and trans fat; no- or low-fat dairy products
> Consume protein in foods preferably with low saturated fats (fish, egg whites, beans); there is no need to avoid animal protein > Avoid or limit processed meats
Micronutrients > Routine supplementation is not necessary > Specifically: chromium, vanadium, magnesium, vitamins A, C, and E,
> Supplementation to avoid insufficiency or deficiency in at-risk patients > A healthful eating meal plan can generally provide sufficient micronutrients
and CoQ10 are not recommended for glycemic control 5 Evidence Grade D-4 B-2
Goal: continue current therapy
Lifestyle/behavioral/diet alone (max 3 months) If target not achieved, initiate drug therapy
Lifestyle/behavioral/diet + drug therapy
Table 5. AACE Healthful Eating Recommendations for Patients with Diabetes Mellitus
