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From the Editor

August, 2016

  • 27 August

    Aug. 27, 2016

    dave

    Last week in our Clinical Series we had an excerpt from International Textbook of Diabetes Mellitus, 4th Ed., looking at Beta-Cell response to nonglucose secretagogues. This text dealt with how the beta cells might be affected by more than just glucose. We are learning more about how fat. protein, and non-insulin peptides might have effects we had never ...

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August, 2016

Test Your Knowledge

Question #848

Clinicians treating patients with type 2 diabetes should include lifestyle interventions when developing diabetes management plans. Which of the following is NOT appropriate?

Correct

Answer: 4. A calorie fixed ADA diet

Educational Critique: All patients with diabetes should participate in a diabetes education program with ongoing support (DSME/DSMS). Lifestyle interventions are a key component of type 2 diabetes management and should address dietary intake and activity levels. Both should be adjusted for individual patient needs. Weight reduction has been shown to improve glycemic control as well as improve cardiovascular risk factors. Physical activity promotes weight loss/maintenance as well as has beneficial effects on lipid profiles, carbohydrate metabolism and insulin sensitivity.

Although still prescribed by some health care professionals, there is no such “diet” or meal plan as an ADA diet.

An individualized Medical Nutrition Therapy (MNT) program, preferably provided by a registered dietitian, is recommended for all people with type 1 or type 2 diabetes.

  •       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.
  •       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.
  •       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.
  •       Because diabetes nutrition therapy can result in cost savings and improved outcomes (e.g., A1C reduction)
  •       MNT should be adequately reimbursed by insurance and other payers.
  •       Energy balance . Modest weight loss achievable by the combination of lifestyle modification and 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.

Eating patterns and macronutrient distribution

  •       As there is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes, macronutrient distribution should be individualized while keeping total calorie and metabolic goals in mind.
  •       Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars.
  •       People with diabetes and those at risk should avoid sugar-sweetened beverages in order to control weight and reduce their risk for CVD and fatty liver B and should minimize the consumption of sucrose-containing foods that have the capacity to displace healthier, more nutrient-dense food choices.

Adapted from:

Nutrition therapy recommendations

Volume 39, Supplement 1, January 2016

Diabetes Care. Volume 39, Supplement 1, January 2016

Incorrect

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