The EAL is seeking RDNs and NDTRs who work with patients, clients, or the public to treat children and adolescents living with type 1 diabetes, for participation in a usability test and focus group. Interested participants should email a professional resume to dhandu@eatright.org by July 15, 2024.

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Recommendations Summary

DM: Fiber Intake (2015)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    DM: Encourage Fiber Intake

    The registered dietitian nutritionist (RDN) should encourage adults with diabetes to consume dietary fiber from foods such as fruits, vegetables, whole grains and legumes, at the levels recommended by the Dietary Reference Intakes (DRI) (21g to 25g per day for adult women and 30g to 38g per day for adult men, depending on age) or U.S. Department of Agriculture (14g fiber per 1, 000kcal) due to the overall health benefits of dietary fiber. Limited research regarding differing amounts of fiber intake from foods, independent of weight loss, reported mixed results on A1C and no significant effects on exogenous insulin levels.

     

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None.

    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions and reimbursement vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • One study with approximate dietary fiber intake of 30g per day in adults with type 1 diabetes reported a beneficial effect on A1c, whereas two studies with approximately 20g per day of dietary fiber intake in adults with type 1 diabetes or type 2 diabetes did not report a beneficial effect on A1c (McCulloch et al, 1985; Milne et al, 1994). None of the studies reported on glucose levels. Additional long-term studies are needed to ascertain the relationship of differing amounts of fiber in the diet, independent of weight loss, on glycemia in adults with diabetes. Grade III
      • One study reports no significant effect of differing amounts of fiber in the diet (20g vs. 30g of dietary fiber per day), independent of weight loss, on insulin doses in adults with type 1 diabetes (McCulloch et al, 1985). No studies were identified in subjects with type 2 diabetes or that reported on endogenous insulin levels. Additional long-term studies are needed regarding the relationship of fiber, independent of weight loss, on insulin levels in adults with diabetes. Grade III
      • One study regarding the relationship of differing amounts of dietary fiber in the diet, independent of weight loss, on CVD risk factors reported no significant effect on total cholesterol, HDL-cholesterol or LDL-cholesterol levels in adults with type 2 diabetes (Milne et al, 1994). However, reported dietary fiber intake (approximately 20g per day) did not differ among the groups. The high carbohydrate and fiber group reported significantly higher soluble fiber intake compared to the weight management group. The study reported that triglyceride levels were lower among subjects consuming less soluble fiber. Subjects did not have or were not described as having any disorders of lipid metabolism or hypertension, and none of the studies reported on blood pressure or adults with type 1 diabetes. Additional long-term studies are needed to ascertain the relationship of differing amounts of fiber in the diet, independent of weight loss, on lipid profile in adults with diabetes, especially those with disorders of lipid metabolism and hypertension. Grade III
      From the 2013 American Diabetes Association Nutrition Therapy Recommendations
      • For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars or sodium. Grade B
      • People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public. Grade C
      From the 2015 American Diabetes Association Standards of Medical Care in Diabetes

      Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care and Immunization
      • Carbohydrate intake from vegetables, fruits, whole grains, legumes and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars or sodium. Grade B
      • Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture recommendation for dietary fiber (14g fiber per 1, 000kcal) and to consume foods containing whole grains (one-half of grain intake). Grade B

    • Recommendation Strength Rationale

      • Conclusion Statements in support of these recommendations were given Grade III
      • The 2013 American Diabetes Association Nutrition Therapy Recommendations received Grades B and C
      • The 2015 American Diabetes Association Standards of Medical Care in Diabetes received Grade B.

    • Minority Opinions

      Consensus reached.