Nutrition Therapy Effectiveness for the Treatment of Type 1 and Type 2 Diabetes: Prioritizing Recommendations Based on Evidence

Marion J. Franz, Zhuoshi Zhang, and Bernard Joseph Venn Key Points

  • • Medical nutrition therapy for diabetes using a variety of nutrition interventions and multiple encounters can lower hemoglobin A1c by ~1-2% depending on the type and duration of diabetes.
  • • For persons with type 1 diabetes
  • - Identify a usual or convenient schedule of foods/meals and physical activity
  • - Integrate insulin therapy and dietary advice into the patient’s lifestyle
  • - Determine insulin-to-carbohydrate ratios, calculate insulin correction factors, and review goals
  • - Provide ongoing support and education
  • • For persons with type 2 diabetes
  • - Focus on metabolic control-glucose, lipids, and blood pressure
  • - Implement nutrition interventions for glucose control
  • - Encourage physical activity
  • - Monitor outcomes to determine if goals are being met or if medications need to be added or changed
  • - Provide ongoing support and education
  • • Research supports consistency in total amount of carbohydrate eaten, fiber intake for lowering of total and LDL cholesterol, no change in protein intake with normal renal function, and reduction in saturated and trans fatty acids and dietary cholesterol.
  • • Research on the glycemic index/load and micronutrient supplementation is controversial.

Keywords Type 1 diabetes • Type 2 diabetes • Nutrition therapy • Insulin therapy • Glycemic index

M.J. Franz, M.S., R.D.N. C.D.E. (*)

Nutrition Concepts by Franz, Inc., 6635 Limerick Drive, Minneapolis, MN 55439, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

Z. Zhang, R.D. • B.J. Venn, Ph.D.

Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, Otago 9054, New Zealand e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing AG 2017

N.J. Temple et al. (eds.), Nutrition Guide for Physicians and Related Healthcare Professionals, Nutrition and Health, DOI 10.1007/978-3-319-49929-1_9


Based on 2012 data, approximately 29 million people in the United States have diabetes, an increase of 5 million from 2007 [1]. The estimated prevalence of total diabetes was 12-14% in total US population. Up to 25-36% of people with diabetes are undiagnosed, a rate that has fluctuated between 25 and 30% over the last few years [2]. Worldwide, it is estimated that 415 million people have diabetes with projections of huge increases into the foreseeable future [3]. Diabetes prevalence increases with age, affecting approximately 25% of those 65 years and older. In North America, the disease is particularly prevalent in ethnic populations, such as African-Americans, Hispanic populations (Latinos and Mexican Americans), Native Americans and Alaska Natives, Asian-Americans, and Pacific Islanders. While much of the rise in the prevalence of type 2 diabetes is seen in the middle-aged and elderly, there is a trend to an earlier age of onset. Evidence shows a rise in type 2 diabetes among younger North Americans; in 10-19-year-olds, type 2 diabetes now accounts for around 9% of recent diagnoses in non-Hispanic whites and 50% or more in ethnic minority groups [4]. Studies have shown that medical nutrition therapy (MNT) can play an important role in assisting persons with diabetes to meet their glucose, lipid, and blood pressure goals and, therefore, should be a major component in the medical management of the disease [5, 6].

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