Nutritional Therapy for Adults with Diabetes or Prediabetes: ADA Consensus

6/11/19
WRITTEN BY: Mariana Gomez
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There is no single approach or nutritional treatment for people with diabetes (any type) or prediabetes. There are different nutritional diet options for different people, and they depend on a number of variables and teamwork with healthcare professionals. Food is one of the essential pillars for the care of our health in general, and there is more talk about glycemic management.

Earlier this year the American Diabetes Association (ADA) published a Consensus on Nutrition Therapy, and presented the major findings at this year’s 79th Scientific Sessions. Although this information is aimed at healthcare professionals, we want to share some of the most interesting points so that, if necessary, you can discuss it with your team to choose the best plan for you.

  1. The specialist in charge: The ADA recommends that a registered dietitian or nutritionist is the best specialist to carry out any diet recommendations. It is suggested, of course, that these specialists are also Certified Diabetes Educators, although it is not a mandatory certification.
  2. The objective: The objectives of any nutritional diet change must be personalized. Each will have different requirements for different nutrients. The evidence makes us see that there is no fixed and ideal percentage of nutrients for people with diabetes or prediabetes but that a plan should be created taking into account the requirements and also, the preferences of the person. One of the objectives in the development of any plan will naturally be the management or control of body weight, but glycemic management remains the highest priority. 
  3. Considerations for carbohydrate intake: You have probably been told that the previous recommendation of the American Diabetes Association was 130g/day of carbohydrates in people with diabetes older than 19 years of age. Today we find other nutritional approaches, and in this consensus, the benefits of many of them are detailed. Once again, the importance of creating personalized plans is highlighted. These 130 grams in some people will be sufficient but in other populations may be reduced while others may be eliminated.

Different plans + diet options

Food Plan Benefits Studies and publications that support this intervention
Mediterranean Diet

Effects on A1c reduction

Effects on weight loss

Lipid Reduction

DIRECT Dietary Intervention Randomized Controlled Trial (DIRECT)
Vegan, Vegetarian

Reduction of blood glucose levels

Reduction of risks of development of Cardiovascular Diseases

Weightloss

Waist Circumference Reduction

Cholesterol Reduction, Triglycerides

Reduction of Blood Pressure.

Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis

Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes

Low Fat

Weight reduction

There was no great improvement in glycemic management

Look AHEAD (Action for Health in Diabetes) Trial

Very Low Fat: Ornish or Pritikin

 

Improvement in blood glucose levels

Weight loss

Improvement in blood pressure levels

Loss of cholesterol levels

Long-term use of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise in the treatment of NIDDM patients
Low Carb and Very Low Carb Diets

A1C reduction

Triglycerides reduction

Greater HDL-C

Lower blood pressure

Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial

Long-term effects of weight loss with a very-low carbohydrate, low saturated fat diet on flow mediated dilatation in patients with type 2 diabetes: a randomised controlled trial

Dash Diet

Weight loss

Improvement in A1C only in one of the tests carried out

Lower blood pressure

Improvement in cholesterol levels

No difference in triglycerides

Effects of the DASH diet and walking on blood pressure in patients with Type 2 diabetes and uncontrolled hypertension: a randomized controlled trial
Paleo Diet Different findings in A1C and weight loss as well as lipid loss Beneficial effects of a Paleolithic diet on cardiovascular risk factors in Type 2 diabetes: a randomized cross-over pilot study
Intermittent Fasting

Weight loss

There was no significant improvement in A1C

Improvement in insulin sensitivity

Intermittent fasting in type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial

Effects of a one-week fasting therapy in patients with type-2 diabetes mellitus and metabolic syndrome—a randomized controlled explorative study

Use of Sweeteners + Alcohol Consumption

It is suggested to replace sugary drinks with sweeteners in things like tea instead. However, consumption should be limited. With alcohol, moderation is the secret: one drink a day for women and two or less for men. Diabetes education should be provided and must include extensive training on hypoglycemia, and the importance of glucose monitoring in cases of consuming alcoholic beverages.

Final Takeaway

This consensus also includes specific data for nutritional intervention in cases of complications such as gastroparesis. The American Diabetes Association places great emphasis, as do we, on teamwork and multidisciplinary management of all types of diabetes. A medical specialist should have the ability to refer you to a nutrition expert with whom you can work on customizing your meal plan.

 


This article is part of Beyond Type 1’s ADA 2019 coverage. For full ADA 2019 coverage, click here.



Mariana Gomez

Mariana was diagnosed with type 1 diabetes in the summer of 1985. She is a Diabetes Educator and a Licensed Psychologist specialized in Narrative. In 2008, Mariana started a blog where she shares her experiences and diabetes knowledge with others and she began being an active advocate through social media. She is considered a diabetes influencer in Latin America and has participated in several conferences, events, and TV shows dedicated to diabetes education in the last years. Mariana worked for the Mexican Diabetes Federation as Communications Manager helping to build and empower the diabetes community in Mexico. She is currently the Program Manager for Beyond Type 1 en Español.