Nutritional Therapy in Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

EFFECTIVENSS OF NUTRITION THERAPY

"1. An individualized MNT program, preferably provided by a registered dietitian, is recommended for all people with type 1 or type 2 diabetes. (Level of Evidence: A)"

"2. For people with type 1 diabetes or those with type 2 diabetes who are prescribed a flexible insulin therapy program, education on how to use carbohydrate counting or estimation to determine mealtime insulin dosing can improve glycemic control (Level of Evidence: A)"

"3.For individuals whose daily insulin dosing is fixed, having a consistent pattern of carbohydrate intake with respect to time and amount can result in improved glycemic control and a reduced risk of hypoglycemia.(Level of Evidence: B)"

"4.A simple and effective approach to glycemia and weight management emphasizing healthy food choices and portion control may be more helpful for those with type 2 diabetes who are not taking insulin, who have limited health literacy or numeracy, and who are elderly and prone to hypoglycemia (Level of Evidence: C)"

"5. Because diabetes nutrition therapy can result in cost savings(Level of Evidence: B) and improved outcomes (e.g., A1C reduction) (Level of Evidence: A)' MNT should be adequately reimbursed by insurance and other payers. (Level of Evidence: E)"

ENERGY BALANCE

"1.Modest weight loss achievable by the combination of lifestyle modification and A the reduction of energy intake benefits overweight or obese adults with type 2 diabetes and also those at risk for diabetes. Interventional programs to facilitate this process are recommended (Level of Evidence: A)"

IMMUNIZATION

"1. Provide routine vaccinations for children and adults with diabetes as for the general population ac- cording to age-related recommendations (Level of Evidence: C)"

"2.Administer hepatitis B vaccine to unvaccinated adults with diabetes who are aged 19–59 years. (Level of Evidence: C)"

"3. Consider administering hepatitis B vaccine to unvaccinated adults with diabetes who are aged >60 years. (Level of Evidence: C)"

PSYCHOSOCIAL ISSUES

"1. The patient’s psychological and social situation should be ad- dressed in the medical manage- ment of diabetes. (Level of Evidence: B)"

"2. Psychosocial screening and follow- up may include, but are not lim- ited to, attitudes about the illness, expectations for medical man- agement and outcomes, affect/ mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. (Level of Evidence: E)"

"3.Routinely screen for psychoso- cial problems such as depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment. (Level of Evidence: B)"

"4. Older adults (aged $65 years) with diabetes should be consid- ered for evaluation of cognitive function and depression screening and treatment. (Level of Evidence: B)"

"5. Patients with comorbid diabetes and depression should receive a stepwise collaborative care ap- proach for the management of depression (Level of Evidence: A)"

COMPREHENSIVE MEDICAL EVALUATION

A complete medical evaluation should be performed at the initial visit to

"1. Confirm the diagnosis and classify diabetes (Level of Evidence: B)"

"2. Detect diabetes complications and potential comorbid conditions. (Level of Evidence: E)"

"3.Review previous treatment and risk factor control in patients with established diabetes (Level of Evidence: E)"

"4. Begin patient engagement in the formulation of a care manage- ment plan. (Level of Evidence: B)"

"5. Develop a plan for continuing care (Level of Evidence: B)"