Diabetes Type 1 and 2

DM: Medical Nutrition Therapy (2001)

Background:

The ADA 2001 Diabetes Nutrition Practice Guideline was originally published in a compact disk (CD) format. This 2001 project was published to the online Evidence Analysis Library in 2005 for the benefit of ADA members, even though it does not follow the current online format and may be missing some of the components. (Current ADA Evidence Analysis Questions include: question, conclusion, grade, search plan and results, evidence summary, overview table, worksheets, and quality check lists.) 

• Assessment
  Nutrition Practice Guideline: Effectiveness of Medical Nutrition Therapy in the management of diabetes types 1 and 2 (2001)

  • Conclusion

    Medical Nutrition Therapy (MNT) using Nutrition Practice Guidelines for both type 1 and type 2 diabetes mellitus resulted in 1% to 2% decreases in A1C (8% to 7%) after 3 to 6 months intervention with an average of 3 counseling sessions with the RD. To be effective, MNT needs to be individualized based on usual food intake to achieve glucose and lipid goals considering the motivational and educational level of the patient. Follow-up MNT is recommended for reinforcement, with changes in medical status or diabetes medications or for intensive treatment of type 1 diabetes.  (2001)

     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Diabetes 1 and 2 and Medical Nutrition Therapy (2001)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Diabetes Association.  Position Statement.  Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care 2002; 25(suppl 1): S50-60.
      • The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.  
      • Delahanty LM. Clinical significance of medical nutrition therapy in achieving diabetes outcomes and the importance of the process.  J Am Diet Assoc 1998; 98:28-30.
      • Franz MJ, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze RS.  Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus:  a randomized controlled clinical trial.  J Am Diet Assoc 1995;95:1009-1017.
      • Franz MJ, Splett PL, Monk A, Barry B, McClain K, Weaver T, Upham P, Bergenstal R, Mazze RS. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995;95:1018-1024.
      • Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, Snetselaar L, Splett P, Wylie-Rosett J, for the Diabetes Care and Education Dietetic Practice Group. Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc 1998; 98(1):62-70.
      • Laitinen JH, Ahola IE, Sarkkinen ES, Winberg RL, Harmaakorpi-Livonen PA, Uusitupa MI. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1993;93(3):276-283.
      • Monk A, Barry B, McClain K, Weaver T, Cooper N, Franz MJ.  Practice guidelines for medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995;95:999-1006.
  Nutrition Practice Guidelines for Type 1 and 2 Diabetes: Self-Management (2001)

  • Conclusion

    Medical Nutrition Therapy (MNT) using Nutrition Practice Guidelines for both type 1 and type 2 diabetes mellitus resulted in 1% to 2% decreases in A1C (8% to7%) after 3 to 6 months intervention with an average of 3 counseling sessions with the RD. To be effective, MNT needs to be individualized based on usual food intake to achieve glucose and lipid goals considering the motivational and educational level of the patient. Follow-up MNT is recommended for reinforcement, with changes in medical status or diabetes medications or for intensive treatment of type 1 diabetes. (2001)

     

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Diabetes 1 and 2 and Medical Nutrition Therapy (2001)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Diabetes Association.  Position Statement.  Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care 2002; 25(suppl 1): S50-60.
      • The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.  
      • Delahanty LM. Clinical significance of medical nutrition therapy in achieving diabetes outcomes and the importance of the process.  J Am Diet Assoc 1998; 98:28-30.
      • Franz MJ, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze RS.  Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus:  a randomized controlled clinical trial.  J Am Diet Assoc 1995;95:1009-1017.
      • Franz MJ, Splett PL, Monk A, Barry B, McClain K, Weaver T, Upham P, Bergenstal R, Mazze RS. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995;95:1018-1024.
      • Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, Snetselaar L, Splett P, Wylie-Rosett J, for the Diabetes Care and Education Dietetic Practice Group. Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc 1998; 98(1):62-70.
      • Laitinen JH, Ahola IE, Sarkkinen ES, Winberg RL, Harmaakorpi-Livonen PA, Uusitupa MI. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1993;93(3):276-283.
      • Monk A, Barry B, McClain K, Weaver T, Cooper N, Franz MJ.  Practice guidelines for medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995;95:999-1006.