Thursday , October 19 2017

Question 827

Mr. Carlson is a 52-year-old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”), left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6%. Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough,” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success, in the past.

Mr. Carlson makes an appointment with a registered dietitian. She discusses with him the benefits of medical nutrition therapy for weight, glycemic control, blood pressure, lipid profile and overall wellbeing. Which following statement regarding macronutrients is true?

Correct

Answer: D. There is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes.

Dietary fat

  • Whereas data on the ideal total dietary fat content for people with diabetes are inconclusive, an eating plan emphasizing elements of a Mediterranean-style diet rich in monounsaturated fats may improve glucose metabolism and lower CVD risk, and can be an effective alternative to a diet low in total fat, but relatively high in carbohydrates.
  • Eating foods rich in long-chain omega-3 fatty acids, such as fatty fish (EPA and DHA), nuts and seeds (ALA), is recommended to prevent or treat CVD B; however, evidence does not support a beneficial role for omega-3 dietary supplements.

Reference(s):

American Diabetes Association. Standards of Medical Care in Diabetes – 2016. Diabetes Care. Jan. 2016; 39(Suppl. 1):S1-S2. http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf

Incorrect