An individual’s diet is considered to contribute to the development of type 2 diabetes, and the evidence is increasing to support the benefits of lifestyle and nutritional interventions to prevent or delay type 2 and gestational diabetes. However, there is no standard meal plan or eating pattern that works universally for all people with diabetes. Therefore, it is recommended that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health-care provider (HCP).

Nutrition Therapy Recommendations for Diabetes in Adults

Medical recommendations, including those for nutrition therapy, are now being developed using an evidence-based approach (Franz et al. 2014). The Academy of Nutrition and Dietetics published evidence-based nutrition recommendations for type 1 and type 2 diabetes in 2010, and in 2013 the American Diabetes Association (ADA) published nutrition therapy recommendations for the management of adults with diabetes using a similar process (Evert et al. 2013). The ADA has long recognized the integral role of nutrition therapy in overall diabetes management and recommends that each person with diabetes receive an individualized eating plan that has been developed in collaboration with his or her health-care provider. A grading system developed by the ADA and modeled on existing methods was used to clarify and codify the evidence that forms the basis for the recommendations. Depending on the quality of evidence, recommendations were assigned ratings of A, B, C, or expert opinion or expert consensus (E) based on no evidence from clinical trials (Evert and Boucher 2014). For evidence rating at the A level, the description is clear evidence from well-conducted, generalizable RCTs that are adequately powered. The recommendations with evidence level A are summarized in Table 5.2, as adapted from the ADA recommendations (Evert and Boucher

2014). It is necessary to compare the term “nutrition therapy” with “medical nutrition therapy” (MNT). MNT is an evidence-based application of the nutrition care process provided by a registered dietitian/nutritionist (RD/N) and is the legal definition of nutrition counseling by an RD/N in the United States; nutrition therapy is the treatment of a disease or condition through the modification of nutrient or whole-food intake. Therefore, nutrition therapy has a broader definition than MNT (Evert and Boucher 2014).

Table 5.2 shows the nutrition therapy recommendations for the management of adults with diabetes, as adapted from the ADA recommendations (Evert and Boucher 2014).

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