Diabetes Type 1 and 2

DM: Introduction (2008)

Guideline Overview

Guideline Title

Diabetes Type 1 and 2 (2008) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for adults with type 1 or type 2 diabetes. Primary goals of MNT for adults with diabetes are to achieve and maintain normal blood glucose levels as safely as possible, a lipid profile that reduces risk for cardiovascular disease, and blood pressure in an ideal range.

Type 1 diabetes is primarily a disease of insulin deficiency. The first priority of MNT for adults requiring insulin is to integrate insulin therapy into their usual eating and physical activity pattern.

Type 2 diabetes is a progressive disease that results from defects in insulin action (insulin resistance) and insulin secretion (insulin deficiency). Priorities of MNT progress from lifestyle interventions for prevention of diabetes to MNT alone for diabetes management to MNT in combination with glucose-lowering medications to MNT with insulin. MNT is based on metabolic goals, strategies proven to assist in the achievement of goals, and lifestyle changes that the adult with diabetes is willing and able to make.

Guideline Development

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT for adults with diabetes. The guideline must be individualized based on the needs of the adult with diabetes, but it will assist the registered dietitian (RD) to successfully integrate MNT into the overall medical management of type 1 and type 2 diabetes. The recommendations in the guideline were based on a systematic review of the literature. Topics include:

Process for providing MNT for adults with diabetes
Carbohydrate—distribution/amount, sucrose, glycemic index, fiber
Protein
Blood glucose monitoring
Prevention and treatment of cardiovascular disease
Weight management
Physical activity

The recommendations are based on the work performed by the ADA diabetes evidence analysis work group. The number of supporting documents for these topics is below:

Recommendations: 18
Conclusion Statements: 15
Evidence Summaries: 15
Article Worksheets: 202

To view the guideline development and review process, click here.

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

Revision

The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see ADA Evidence Analysis Manual).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Diabetes

Scientific evidence supports the effectiveness of medical nutrition therapy to increase effectiveness of diabetes therapy. Topics included in this guideline are:

Use of medical nutrition therapy and dietitian intervention
Reduction of blood glucose levels
Reduction of hemoglobin A1C
Reduction of blood pressure
Reduction of risk factors for cardiovascular disease

The registered dietitian plays an integral role on the interdisciplinary healthcare team by making the optimal nutrition prescription and developing the nutrition intervention plan for patients undergoing diabetes therapy. Based on the client's treatment plan and comorbid conditions, other nutrition practice guidelines, such as adult weight management, hypertension, disorders of lipid metabolism, critical illness and nutrition care in bariatric surgery may be needed in order to provide optimal treatment.

Populations to Whom This Guideline May Apply

This guideline applies to adults with type 1 or type 2 diabetes mellitus.

Other Guideline Overview Material

For more details on the guideline components, use the links on the left to access:

Scope of Guideline
Statement of Intent and Patient Preference
Guideline Methods
Implementation of the Guideline
Benefits and Harms of Implementing the Recommendations

Contraindications

Clinical judgment is crucial in the application of these guidelines. Careful consideration should be given to the application of these guidelines for patients with significant medical co-morbidities.