Diabetes dietary recommendations of american diabetes association

• Individuals who have pre-diabetes or diabetes should receive individualized MNT; such therapy is best provided by a RD (registered dietitian) familiar with the components of diabetes MNT (medical nutrional therapy). (B)
• Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. (E)

Energy Balance, Overweight, and Obesity

• For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

Carbohydrate in Diabetes Management

• A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. (B)
• Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation, remains a key strategy in achieving glycemic control. (A)
• The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. (B)
• Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake. (A)
• As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. However, evidence is lacking to recommend a higher fiber intake for people with diabetes than for the population as a whole. (B)
• Sugar alcohols and non-nutritive sweeteners are safe when consumed within the daily intake levels established by the FDA. (A)

Dietary Fat and Cholesterol in Diabetes Management

• Limit saturated fat to <7% of total calories. (A)
• Intake of trans fat should be minimized. (E)
• In individuals with diabetes, limit dietary cholesterol to <200 mg/day. (E)
• Two or more servings of fish per week (with the exception of commercially fried fish filets) provide n-3 polyunsaturated fatty acids and are recommended. (B)

Protein in Diabetes Management

• For individuals with diabetes and normal renal function, there is insufficient evidence to suggest that usual protein intake (15% to 20% of energy) should be modified. (E)
• In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations. Therefore, protein should not be used to treat acute or prevent nighttime hypoglycemia. (A)
• High-protein diets are not recommended as a method for weight loss at this time. The long-term effects of protein intake >20% of calories on diabetes management and its complications are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown. (E)

Alcohol in Diabetes Management

• If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for women and two drinks per day or less for men). (E)
• To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. (E)
• In individuals with diabetes, moderate alcohol consumption (when ingested alone) has no acute effect on glucose and insulin concentrations but carbohydrate co-ingested with alcohol (as in a mixed drink) may raise blood glucose. (B)

Micronutrients in Diabetes Management

• There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes (compared with the general population) who do not have underlying deficiencies. (A)
• Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. (A)
• Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore cannot be recommended.

Nutrition Interventions for Older Adults with Diabetes

• Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight. (E)
• A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. (C)