6
Nutrition Intervention
DM: Educate Adults with Type 2 Diabetes on MNT Alone or
Non-Insulin Secretagogues
➤ The RDN should educate adults with type 2 diabetes on MNT alone or
on diabetes medications other than insulin secretagogues, based on
his or her abilities, preferences and management goals, on one of the
following carbohydrate management strategies:
• Carbohydrate counting alone
• Plate method, portion control and simplified meal plan
• Food lists (such as Choose Your Foods. Food Lists for Diabetes) and
carbohydrate choices.
Monitoring carbohydrate intake, whether by carbohydrate counting
or experience-based estimation remains a key strategy in achieving
glycemic control. A simple diabetes healthful eating plan approach
such as portion control or healthful food choices may be better suited
to individuals with type 2 diabetes who have low health literacy or
numeracy concerns. (Fair, Conditional)
DM: Encourage Fiber Intake
➤ The RDN should encourage adults with diabetes to consume dietary
fiber from foods such as fruits, vegetables, whole grains and legumes,
at the levels recommended by the Dietary Reference Intakes (21–25 g
per day for adult women and 30–38 g per day for adult men, depending
on age) or U.S. Department of Agriculture (14 g fiber/1,000 kcal) due to
the overall health benefits of dietary fiber. Limited research regarding
differing amounts of fiber intake from foods, independent of weight
loss, reported mixed results on A1C and no significant effects on
exogenous insulin levels. (Fair, Imperative)
DM: Advise on Glycemic Index and Glycemic Load
➤ If glycemic index or glycemic load is proposed as a glycemia-lowering
strategy, the RDN can advise adults with diabetes that lowering
glycemic index or glycemic load may or may not have a significant
effect on glycemic control. Studies ≥12 weeks report no significant
impact of glycemic index or glycemic load, independent of weight
loss, on A1C. However, mixed results were reported regarding fasting
glucose levels and endogenous insulin levels. (Fair, Conditional)
