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Nutrition Therapy Recommendations For The Management Of Adults With Diabetes 2017

Adas 2017 Guidelines Support The Beneficial Role Of Low Calorie Sweeteners In Diabetes Management

Adas 2017 Guidelines Support The Beneficial Role Of Low Calorie Sweeteners In Diabetes Management

ADAS 2017 Guidelines Support The Beneficial Role Of Low Calorie Sweeteners In Diabetes Management ADAs 2017 guidelines support the beneficial role of low calorie sweeteners in diabetes management Over the last 25 years, the American Diabetes Association s (ADAs) Standards of Medical Care in Diabetes1 remain a reference point in diabetes management, as they are updated annually, aiming to provide clinicians, patients and researchers with the latest evidence-based principles on diabetes care, prevention and treatment. Low calorie sweeteners role in the diet: what ADAs new standards support Low calorie sweeteners can be a helpful tool in the diet of people with diabetes, as they do not increase blood glucose or insulin levels. The American Diabetes Association recognises that for people who are accustomed to sugar-sweetened products, non-nutritive sweeteners have the potential to reduce overall calorie and carbohydrate intake and may be preferred to sugar when consumed in moderation.2 Furthermore, ADA acknowledges low calorie sweeteners safety, as already confirmed by food safety authorities around the world , further adding that regulatory agencies set acceptable daily intake levels for each non-nutritive sweetener, defined as the amount that can be safely consumed over a persons lifetime. Based on the available literature3, 4, ADA concludes in its Medical Nutrition Therapy (MNT) recommendations, The use of non-nutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners and without compensation by intake of additional calories from other food sources. Non-nutritive sweeteners are generally safe to use within the defined acceptable daily intake levels. New recommendations on lifestyle management in this ye Continue reading >>

The American Diabetes Association Commends The Release Of The 2015-2020 Dietary Guidelines For Americans To Promote Healthier Living

The American Diabetes Association Commends The Release Of The 2015-2020 Dietary Guidelines For Americans To Promote Healthier Living

The American Diabetes Association Commends the Release of the 2015-2020 Dietary Guidelines for Americans to Promote Healthier Living The American Diabetes Association is pleased with overarching guidelines in the current edition that encourage following healthy eating patterns and choosing a variety of nutrient-dense foodsincluding vegetables, fruits, whole grains, fat-free or low-fat dairy, a variety of protein foods and oilsin recommended amounts. We are also pleased to see the Guidelines emphasize strategies that help Americans shift to healthier food and beverage choices and support healthy eating patterns for all. These recommendations are important to the health of all Americans, including the nearly 30 million Americans with diabetes and 86 million Americans with prediabetes. It is the position of the Association that there is not a "one-size-fits-all" eating pattern for individuals with diabetes, per our 2013 Nutrition Therapy Recommendations for the Management of Adults With Diabetes . Healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, are key in assisting individuals with diabetes to improve their overall health, and specifically to attain individualized glycemic, blood pressure and lipid goals; achieve and maintain body weight goals; and delay or prevent complications of diabetes. Many of the recommendations in the updated Guidelines are consistent with the previous edition, released in 2010. However, the addition of a specific limit on consumption of added sugars is noteworthy. To achieve healthy eating patterns within calorie limits, the updated Guidelines recommend that individuals consume less than 10 percent of calories per day from added sugars. The Association supports the need for individuals to cho Continue reading >>

Nutritional Considerations In Type 2 Diabetes Mellitus

Nutritional Considerations In Type 2 Diabetes Mellitus

INTRODUCTION Diet is one of the most important behavioral aspects of diabetes treatment. Basic principles of nutritional management, however, are often poorly understood by both clinicians and their patients. The role of nutrition and the development of a medical nutrition therapy (MNT) plan for a patient with type 2 diabetes are discussed here. Nutrition for patients with type 1 diabetes, as well as diets for the prevention of diabetes and for weight loss in general, are discussed separately. GOALS OF NUTRITIONAL THERAPY The nutrition prescription for patients with type 2 diabetes should optimally manage the "ABCs" of diabetes control: glycated hemoglobin (A1C), blood pressure, and low-density lipoprotein (LDL) cholesterol. The prescription must be tailored for the individual patient to further address existing or at-risk complications related to diabetes or other concomitant conditions. Continue reading >>

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

Nutrition Therapy Recommendations for the Management of Adults With Diabetes Joshua J. Neumiller, PHARMD, CDE, CGP, FASCP7, 1University of Washington Medical Center, Seattle, Washington 2Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 3Department of Endocrinology, ABQ Health Partners, Albuquerque, New Mexico 4American Diabetes Association, Alexandria, Virginia 5Nutrition Concepts by Franz, Minneapolis, Minnesota 6Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 7Department of Pharmacotherapy, Washington State University, Spokane, Washington 8University of Michigan Medical School and the Center for Preventive Medicine, Ann Arbor, Michigan 9pbu consulting, llc., Cloquet, Minnesota 10Duke University School of Medicine, Durhum, North Carolina Corresponding authors: Alison B. Evert, atevert{at}u.washington.edu, and Jackie L. Boucher, jboucher{at}mhif.org. Diabetes Care 2013 Nov; 36(11): 3821-3842. Continue reading >>

Type 2 Diabetes: Changing The Paradigm From Management To Reversal

Type 2 Diabetes: Changing The Paradigm From Management To Reversal

Results from the first 70 days of the Virta Clinic trial suggest the historic dietary approach to management of type 2 diabetes has been all wrong. Type 2 diabetes (T2D) has long been viewed as a chronic condition that can be managed but is inevitably progressive.1 While clinicians may be increasingly more aware that T2D can be reversed, most think it is only possible through drastic means like bariatric surgery. With the recent findings from our ongoing clinical trial, which add to the existing literature, medicine may be on the cusp of a major paradigm shift for the treatment of T2D: from management to reversal without the use of surgery. The published results highlight the first 70 days of an ongoing 2-year clinical trial collaboration between Virta Health and Indiana University Health, in which 262 patients with T2D were enrolled in the Virta Clinic.2 The clinic combines online education for behavior change, biometric feedback, peer support and an individualized nutritional approach that promotes nutritional ketosis. After 70 days and greater than 90% retention, mean weight loss was 7.2% and the mean glycated hemoglobin (A1C) reduction was 1%, with 56% of patients achieving an A1C below 6.5%. It is extremely important to note that this reduction in A1C was achieved while medications were reduced. At baseline, 89% of the patients were taking one or more diabetes medications, and at 70 days 58% of patients had either reduced or completely eliminated their medications. This is unlike treatment strategies aimed to lower A1C in the past. For example, in the ACCORD trial,3, where A1C levels were lowered with aggressive medication use, the most aggressively treated patients had worse outcomes. Specifically, the intensive glycemic control group who were prescribed more medi Continue reading >>

Nutrition Therapy In Diabetes Managementan Overview Of The Recent American Diabetes Association Position Statement

Nutrition Therapy In Diabetes Managementan Overview Of The Recent American Diabetes Association Position Statement

Nutrition Therapy in Diabetes ManagementAn Overview of the Recent American Diabetes Association Position Statement US Endocrinology, 2014;10(1):169 DOI: The 2013 American Diabetes Association position statement on nutrition therapy for adults living with diabetes replaces previous position statements, the last of which was published in 2008. This article reviews highlights of the recently published recommendations. Following a healthful eating plan, along with physical activity and often diabetes medicine, is an essential component of the overall treatment plan for the management of diabetes. It is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and supports its implementation. Keywords: Nutrition therapy, eating pattern, nutrition interventions Disclosure: Alison B Evert, MS, RD, CDE serves on the certified diabetes educator advisory board for Medtronic Diabetes. Acknowledgments: The author gratefully acknowledges all the members of the writing committee for their expertise, knowledge, and time devoted to completing the 2013 American Diabetes Association (ADA) Nutrition Recommendations: Co-Chair, Jackie L Boucher, MS, RD, CDE; Stephanie A Dunbar, MPH, RD; Cassandra L Verdi, MPH, RD; Patti Urbanski, MED, RD, LD, CDE; William S Yancy JR, MD, MHSC; Marion J Franz, MS, RD, CDE; Joshua J Neumiller, PharmD, CDE, CGP, FASCP; Marjorie Cypress, PHD, C-ANP, CDE; Elizabeth J Mayer-Davis, PHD, RD; and Robin Nwankwo, MPH, RD, CDE. Received: April 07, 2014 Accepted May 19, 2014 Correspondence: Alison B Evert, MS, RD, CDE, University of Washington Medical Center, Diabetes Care Center, Box 354691, 4245 Roosevelt Way NE, 3rd Floor, Seattle, WA 98105, US. E: [email protected] An erratum to this article can be found below. Ever Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

American Diabetes Association (ADA) Nutrition Guidelines for Adults With Diabetes Source: Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(suppl 1):S120-S143. Available here. Refer to source document for full recommendations, including level of evidence rating. Jump to a topic Nutrition Therapy Energy Balance Macronutrients Eating Patterns Carbohydrates Sweeteners Protein Fats Dietary Omega-3 Micronutrients, Herbal Supplements Alcohol Sodium Priorities for All Patients Priorities by Medication Insulin Requirements Summary Component of overall treatment for all with types 1 and 2 diabetes No “one-size-fits-all” eating approach Chosen eating pattern should improve glucose, BP, and lipid Individualized nutrition therapy, ideally provided by registered dietitian Type 1 Flexible insulin therapy education program using carb counting meal planning Fixed-dose daily insulin Consistent carb intake (time, amount) Type 2 Portion control, healthful food choices for literacy concerns, older adults DSME and support at diagnosis and thereafter Overweight/obese adults with type 2 diabetes For weight loss: reduce energy intake while maintaining healthful eating pattern Optimal macronutrient intake to reduce weight not established Modest weight loss may improve glycemia, BP, lipids Particularly early in disease process Recommended for modest weight loss Intensive lifestyle interventions: nutrition therapy counseling, physical activity, behavior change Ongoing support No ideal percentage of calories from carbohydrate, protein, or fat for individuals with diabetes Macronutrient distribution to be based on individualized assessment of Consider personal preferences and metabolic goals when recommen Continue reading >>

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

Nutrition Therapy Recommendations for the Management of Adults With Diabetes Joshua J. Neumiller, PHARMD, CDE, CGP, FASCP7, 1University of Washington Medical Center, Seattle, Washington 2Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 3Department of Endocrinology, ABQ Health Partners, Albuquerque, New Mexico 4American Diabetes Association, Alexandria, Virginia 5Nutrition Concepts by Franz, Minneapolis, Minnesota 6Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 7Department of Pharmacotherapy, Washington State University, Spokane, Washington 8University of Michigan Medical School and the Center for Preventive Medicine, Ann Arbor, Michigan 9pbu consulting, llc., Cloquet, Minnesota 10Duke University School of Medicine, Durhum, North Carolina Corresponding authors: Alison B. Evert, atevert{at}u.washington.edu, and Jackie L. Boucher, jboucher{at}mhif.org. Diabetes Care 2013 Nov; 36(11): 3821-3842. A healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat. It is the position of the American Diabetes Association (ADA) that there is not a one-size-fits-all eating pattern for individuals with diabetes. The ADA also recognizes the integral role of nutrition therapy in overall diabetes management and has historically recommended that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider, which includes the collaborative development of an individualized eating plan (1,2). Therefore, it is important that all members of the he Continue reading >>

Intensive Lifestyle Intervention For Type 2 Diabetesreply

Intensive Lifestyle Intervention For Type 2 Diabetesreply

Intensive Lifestyle Intervention for Type 2 DiabetesReply 1Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark JAMA. 2017;318(24):2494-2495. doi:10.1001/jama.2017.17240 Effect of a Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes Mette YunJohansen,MSc; Christopher ScottMacDonald,MSc; Katrine BaggeHansen,MD, PhD; KristianKarstoft,MD, PhD; RobinChristensen,PhD; MariaPedersen,MD, PhD; Louise SeierHansen,MSc; MortenZacho,MSc; Anne-SophieWedell-Neergaard,MD; Signe TellerupNielsen,MD, PhD; Ulrik WiningIepsen,MD, PhD; HenningLangberg,DMSc; Allan ArthurVaag,DMSc; Bente KlarlundPedersen,DMSc; MathiasRied-Larsen,PhD In Reply Dr Giugliano and colleagues raise concerns about the lack of information on type 2 diabetes remission as an outcome in our trial, which complicates comparisons with other lifestyle intervention studies. Moreover, the authors suggest that the lower HbA1c levels at entry to the study may have been responsible for the modest reduction in HbA1c and that physical activity is of lesser importance compared with different dietary components in the care of patients with type 2 diabetes. Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106. Available here. Refer to source document for full recommendations, including class of recommendation and level of evidence. Jump to a topic or click back/next at the bottom of each page Lifestyle Changes Medical Nutrition Therapy (MNT) The ADA acknowledges that there is no one-size-fits-all eating pattern for individuals with type 2 diabetes. MNT is recommended for all individuals with type 1 and type 2 diabetes as part of an overall treatment plan, preferably provided by a registered dietitian skilled in diabetes MNT Goals of MNT: A healthful eating pattern to improve overall health, specifically: Achievement and maintenance of weight goals Attainment of individualized glycemic, blood pressure, and lipid goals Type 2 diabetes prevention or delay Attain individualized glycemic, blood pressure, and lipid goals Achieve and maintain body weight goals Delay or prevent diabetes complications Nutrition guidelines from the ADA are available. Click here for summary recommendations on coordinating foods with diabetes medications, eating patterns, and more. Physical Activity Adults with diabetes Exercise programs should include ≥150 min/wk moderate-intensity aerobic activity (50%-70% max heart rate), spread over ≥3 days/wk with no more than 2 consecutive days without exercise Resistance training ≥2 times/wk (in absence of contraindications)* Reduce sedentary time = break up >90 minutes spent sitting Evaluate patients for contraindications prohibiting certain types of exercise before recommending exercise program† Consider age and previous level of physical activity Children with diabetes, prediabetes ≥60 min physical activity/day *Adults with typ Continue reading >>

Nutrition Therapy Recommendations For Diabetes

Nutrition Therapy Recommendations For Diabetes

Nutrition Therapy Recommendations for Diabetes Coordinator of Diabetes Education Programs Alison B. Evert, MS, RD, CDE, has indicated to Physicians Weekly that she has worked as a consultant for Medtronic Diabetes as a member of the Certified Diabetes Educator Advisory Board. Coordinator of Diabetes Education Programs Alison B. Evert, MS, RD, CDE, has indicated to Physicians Weekly that she has worked as a consultant for Medtronic Diabetes as a member of the Certified Diabetes Educator Advisory Board. The American Diabetes Association recently released nutrition therapy recommendations for the management of diabetes. Published in Diabetes Care, the new statement provides a set of recommendations based on reviews of recent clinical investigations ( Table 1) . The statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriately portioned sizes as part of an eating plan. These plans must take into account individual preferences, culture, religious beliefs, traditions, and metabolic goals. The American Diabetes Association recognizes that nutrition therapy is provided by a variety of health professionals, and published research shows that it is effective when delivered by various health professionals. Studies suggest that nutrition therapy produces A1C reductions similar or greater than what is expected with treatment with currently available pharmacologic treatments for diabetes. Ideally, patients with diabetes should be referred to registered dietitians (RDs) for diabetes nutrition therapy or participate in diabetes self-management education (DSME) programs that include instruction on nutrition soon after their diagnosis, says Alison Evert, MS, RD, CDE, who was part of the writing group that developed the position statement Continue reading >>

4. Lifestyle Management

4. Lifestyle Management

Lifestyle management is a fundamental aspect of diabetes care and includes diabetes self-management education (DSME), diabetes self-management support (DSMS), nutrition therapy, physical activity, smoking cessation counseling, and psychosocial care. Patients and care providers should focus together on how to optimize lifestyle from the time of the initial comprehensive medical evaluation, throughout all subsequent evaluations and follow-up, and during the assessment of complications and management of comorbid conditions in order to enhance diabetes care. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT Recommendations In accordance with the national standards for diabetes self-management education and support, all people with diabetes should participate in diabetes self-management education to facilitate the knowledge, skills, and ability necessary for diabetes self-care and in diabetes self-management support to assist with implementing and sustaining skills and behaviors needed for ongoing self-management, both at diagnosis and as needed thereafter. B Effective self-management and improved clinical outcomes, health status, and quality of life are key goals of diabetes self-management education and support that should be measured and monitored as part of routine care. C Diabetes self-management education and support should be patient centered, respectful, and responsive to individual patient preferences, needs, and values and should help guide clinical decisions. A Diabetes self-management education and support programs have the necessary elements in their curricula to delay or prevent the development of type 2 diabetes. Diabetes self-management education and support programs should therefore be able to tailor their content when prevention of diabetes is the desired goal Continue reading >>

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at www.annals.org on 1 March 2016. From St. Mark's Hospital and St. Mark's Diabetes Center, Salt Lake City, Utah; Glytec, Greenville, South Carolina; and University Physicians Primary Care, Augusta, Georgia. Acknowledgment: The authors thank Sarah Bradley; Jane Chiang, MD; Matt Petersen; and Jay Shubrook, DO, for their invaluable assistance in the writing of this manuscript. Disclosures: Dr. Chamberlain reports personal fees (speakers bureau) from Merck, Sanofi Aventis, and Janssen during the conduct of the study. Dr. Rhinehart reports personal fees from Sanofi, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Forest, and Glytec outside the submitted work. Dr. Shaefer reports personal fees from Sanofi, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Janssen, Forest Pharmaceuticals, and Vivus; and nonfinancial support from Sanofi outside the submitted work. Ms. Neuman has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3016 . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relations Continue reading >>

The Role Of Carbohydrate In Diabetes Management

The Role Of Carbohydrate In Diabetes Management

The role of carbohydrate in the diet of people living with diabetes is an area of much debate. This relates to both type and quantity of carbohydrate consumed, with low carbohydrate diets increasing in popularity. However, it is important to take a whole diet approach and not just in terms of single nutrients. This review considers what carbohydrates are and how recommendations for people with diabetes might differ from those for the general population. There are no obligate requirements for dietary carbohydrate. UK recommendations suggest 50% of total energy should come from carbohydrate for the general population; however, evidence does not support an optimal carbohydrate intake for people living with diabetes. Equally, there is no evidence to support a change in other macronutrient intakes including fat; thereby challenging the perspective of low carbohydrate diet advocates, which may encourage higher saturated fat intakes. Carbohydrate quality is important in terms of glycaemic index and fibre, and may have other health benefits; however, the quantity of carbohydrate is a more important predictor of glycaemic response. People with type 1 diabetes can improve the accuracy of insulin dosing with carbohydrate counting and technology may also have a role to play in this, with the introduction of bolus advisor meters. There is no universal recommendation for the amount of carbohydrate for people living with diabetes. Recommendations should therefore be based on personal preference, individual glycaemic response and other health targets, ideally with the support of a registered dietitian specialising in diabetes. Introduction The role of dietary carbohydrate in diabetes is the subject of much debate – especially with respect to ideal amounts and types of carbohydrate.1 Continue reading >>

American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes

American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes

ARLINGTON, Va., Dec. 8, 2017 /PRNewswire/ -- Notable new recommendations in the 2018 edition of the American Diabetes Association's (ADA's) Standards of Medical Care in Diabetes (Standards of Care) include advances in cardiovascular disease risk management including hypertension; an updated care algorithm that is patient-focused; the integration of new technology into diabetes management; and routine screening for type 2 diabetes in high-risk youth (BMI >85th percentile plus at least one additional risk factor). The Standards of Care provide the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes, strategies to improve the prevention or delay of type 2 diabetes, and therapeutic approaches that reduce complications and positively affect health outcomes. The Standards of Care are published annually and will be available online at 4:00 p.m. ET, December 8, 2017, and as a supplement to the January 2018 print issue of Diabetes Care. Experience the interactive Multichannel News Release here: Beginning in 2018, the ADA will update and revise the online version of the Standards of Care throughout the year with necessary annotations if new evidence or regulatory changes merit immediate incorporation. This will ensure that the Standards of Care provide clinicians, patients, researchers, health plans and policymakers with the most up-to-date components of diabetes care, general treatment goals and tools to evaluate the quality of care. The Standards of Care will also be available as a user-friendly and interactive app for both web and mobile devices in the spring of 2018. The app will allow clinicians to access the most up-to-date information conveniently and will include interac Continue reading >>

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