Perspective:

The following are 10 points to remember about this position statement on nutrition therapy recommendations for the management of adults with diabetes:

1. Nutrition therapy is recommended for type 1 and type 2 diabetics. Registered dietitians should be adequately reimbursed by insurance and other payers for providing 3-4 encounters lasting 45-90 minutes.

2. Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Macronutrient calorie distribution should be based on individualized assessment of current eating patterns and preferences (tradition, culture, religion, health beliefs, economics), and metabolic goals.

3. Substituting low–glycemic load foods for higher–glycemic load foods may modestly improve glycemic control. People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public (at least 25 g).

4. Modest weight loss in overweight or obese diabetics may provide clinical benefits (improved glycemia, blood pressure, and/or lipids) in some individuals, especially those early in the disease process. To achieve modest weight loss, intensive lifestyle interventions (counseling about nutrition therapy, physical activity, and behavior change) with ongoing support are recommended.

5. A simple diabetes meal planning approach such as portion control or healthful food choices may be better suited to individuals with type 2 diabetes identified with health and numerous literacy concerns. This may also be an effective meal planning strategy for older adults.

6. Use of non-nutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if not associated with additional calories from other food sources. Fructose consumed as ‘free fructose’ (i.e., naturally occurring in foods such as fruit) is not likely to have detrimental effects on triglycerides as long as intake is not excessive (>12% of total energy intake).

7. In type 2 diabetes, a Mediterranean-style, monounsaturated fatty acid–rich eating pattern may benefit glycemic control and cardiovascular disease risk factors, and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.

8. Evidence does not support recommending omega-3 (EPA and DHA) for the prevention or treatment of cardiovascular events. An increase in foods containing long-chain omega-3 fatty acids from fatty fish (two servings per week) is recommended for effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies.

9. Sodium intake should be less than 2,300 mg/day, or less in those with hypertension. There is insufficient evidence to support the use of cinnamon or other herbs or micronutrient supplements of any kind.

10. Alcohol intake should be in moderation (maximum of 1 oz. spirits equivalent for women and 2 oz. for men). Patients need to be aware that alcohol may result in delayed hypoglycemia.