By Colin Kenny, Editor – Diabetes Distilled
Adults with prediabetes should be provided with individualised nutritional therapy and the latest American Diabetes Association (ADA) consensus report includes guidance on how to support these individuals. This consensus updates the 2014 ADA position statement and aims to provide clarity on the many food choices and eating patterns that can help people with prediabetes, type 1 or type 2 diabetes to achieve health goals and maintain quality of life. The guidance suggests that all members of the healthcare team should support nutrition therapy as an important component of quality diabetes care. Many of the suggested diets are critically appraised. The guidance promotes and supports healthful eating patterns, emphasising a variety of nutrient-dense foods, along with appropriate portion sizes, to improve health and well being.
For the first time, ADA nutritional guidance has included advice on supporting individuals with prediabetes. Updated guidance emphasises that there is no single applicable diet for the patient with prediabetes or diabetes, just as there is no specific proportion of macronutrients in the diet that is useful for everyone. It mentions that low-carbohydrate diets appear to provide some benefits in type 2 diabetes and prediabetes. The optimal amount of fat in the diabetic patient’s diet, however, is controversial or unclear; the ADA considers it more important to look at the nature of the fats consumed. The ADA also found that there was no clear evidence to recommend a specific amount or range of protein in the dietary management of diabetes.
ADA guidance suggests that the amount of sodium in the diet of people with diabetes be the same as for the non-diabetic population. Patients should not consume more than 2.3 g of salt per day, although this amount may be reduced in patients with hypertension. There is a lack of evidence for supplementing the diet with vitamins, minerals, antioxidants or herbal preparations in patients with diabetes. Alcohol consumption in people with diabetes and prediabetes carries a risk of hypoglycaemia, hyperglycaemia and weight gain; moderation is therefore recommended. Finally, the guidance recognises that one of the greatest difficulties for patients with diabetes is adhering to dietary recommendations, so the individualisation of these recommendations is fundamental in achieving the necessary adherence.
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