Monday, November 04, 2013

ADA Position Statement On Nutrition Therapy For Diabetes

The American Diabetes Association (ADA) recently published their new Position Statement on nutrition therapy for people with diabetes:

Nutrition Therapy Recommendations for the Management of Adults With Diabetes, Diabetes Care, Published online ahead of print, 9 October 2013.

The new statement replaces all previous statements, the last of which was published in Diabetes Care in 2008: "Nutritional Recommendations and Interventions for Diabetes."

It is evidence-based, with 246 references and a grading system "used to clarify and codify the evidence."

The Statement considered several popular diets* or eating styles, including Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), plant-based (vegan or vegetarian), lower-fat, and lower-carbohydrate, but didn't recommend any one in particular, emphasizing the need to consider personal preference:
"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.

"A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes. Personal preferences (e.g., tradition, culture, religion, health beliefs and goals, economics) and metabolic goals should be considered when recommending one eating pattern over another."
It recommends that people with diabetes receive structured education in nutrition therapy, either from a nutrition professional or a comprehensive DSME (Diabetes Self-Management Education) program:
"The ADA [recommends] that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider."
They may not have homed in on one eating pattern, but they did have a lot to say, backed by evidence, about the three macronutrients (carbohydrate, fat, and protein), and other dietary considerations. I'll be posting about their discussions on these topics in the coming days.

* The word "diet" doesn't appear in the Statement at all. Lead author Alison Evert, MS, RD, CDE, told Medscape Medical News.
"Throughout the document, we refer to 'eating plans' or 'eating patterns' rather than 'diet.' We want to work with patients and help them achieve individual health goals. A variety of eating patterns can help, and people are more likely to follow an eating plan that speaks to them."