Diabetes: Prevention of Type 2

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Diabetes: Prevention of Type 2

Welcome to the Diabetes: Prevention of Type 2 Project

Effectiveness of Dietitian Interventions in Adults with Prediabetes

Prediabetes is broadly defined as an intermediate state of hyperglycemia where blood glucose levels are higher than what is considered a healthy cardiometabolic state, but lower than the diagnostic criteria for Type 2 Diabetes Mellitus (T2DM)1. It is crucial to identify and treat prediabetes as individuals with prediabetes are at higher risk of developing T2DM1. It is estimated that 25% of individuals with prediabetes will develop T2DM within three to five years with approximately 70% developing T2DM during their lifetime [1]. Importantly, prediabetes is considered reversible and lifestyle strategies that reduce insulin resistance have allowed individuals with prediabetes to achieve healthy blood glucose levels, thereby removing the prediabetes diagnosis 1.

Findings from this systematic review support the importance of Medical Nutrition Therapy (MNT) in the treatment plan for individuals at risk of developing T2DM. MNT provided by a dietitian or international equivalent is effective in improving glycemic control and cardiometabolic risk factors for adults with prediabetes.  MNT is a sustainable and cost-effective strategy for prediabetes that can be used in diverse communities 2,3.  

This systematic review and meta-analysis found: 

  • MNT provided by a dietitian may reduce Hemoglobin A1c, certainty of evidence was low; and reduce fasting blood glucose, certainty of evidence was moderate.  
  • MNT provided by a dietitian may reduce body weight, waist circumference, total cholesterol, and blood pressure, certainty of evidence was moderate; and reduce LDL cholesterol and increase HDL cholesterol, certainty of evidence was low.
  • The effect of MNT provided by a dietitian on the incidence of T2DM was uncertain.


Prevention of Type 2 Diabetes Systematic Review and Guideline (2013-2014) 

The focus of the 2014 guideline was on MNT for individuals who are at high risk for type 2 diabetes, such as individuals with prediabetes (including children and adolescents) and adults with metabolic syndrome. The primary goals of MNT are to improve glycemic control and minimize the impact of other comorbidities, such as obesity, hypertension and disorders of lipid metabolism, in order to prevent progression to type 2 diabetes.

The focus of the systematic review was to separate out the impact of each intervention on specified outcomes, without the influence of weight loss.

Highlights of this project include:

  • Guideline recommendations focus on the following major outcomes:
    • Glycemic outcomes (specifically fasting blood glucose, 2 hour post prandial blood glucose, and A1C)
    • Lipid outcomes (specifically triglycerides and HDL cholesterol levels)
    • Anthropometric outcomes (specifically waist circumference and waist-to-hip ratio)
    • Blood pressure outcomes (specifically systolic and diastolic blood pressure)
    • Renal outcomes (specifically urinary albumin excretion rate and albumin:creatinine ratio).
  • Systematic Review focused on the following subtopics:
    • Fat, fiber, fruits and vegetables, glycemic index/load, protein, sugars, whole and refined grains
    • Medical nutrition therapy
    • Physical activity
    • Macronutrient distribution
    • Weight loss

Use the links on the left to review the results of the systematic review. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, conflict of interest disclosures, and project funding information. Expand the section titled Project Resources and Articles to view publications developed from this project.


References:

  1. Hostalek U. Global epidemiology of prediabetes - present and future perspectives. Clin Diabetes Endocrinol. 2019;5:5. 
  2. Briggs Early K, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet. 2018 Feb;118(2):343–53. 
  3. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015 Sep;115(9):1447–63. 
  • Prevention of Type 2 Systematic Review and Guideline Project Team (2013-2014)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Patricia G. Davidson, DCN, MS, RDN, CDE, Chair
    • Micki D. Hall, MS, RD, LD, CDE
    • Healther Holden-Burns, MEd, RD, LD, CDE
    • Shelley Mesznik, MA, RD, CDE, CDN
    • Hollie Raynor, PhD, RD, LDN
    • Virginia Uhley, PhD, RD
    • Jeanene J. Fogli, PhD, RD, LDN (resigned)
    • Andra K. Garber, PhD (resigned)

    Project Manager/Lead Analyst

    • Erica K. Gradwell, MS, RD

    Evidence Analysts

    • Ivonne Angler, MMSc, LND, RD
    • Sue Benson-Davies, DCN, MPH, RD
    • Laura Cook, PhD, RD, ND(FL)
    • Leonore Hodges, PhD, RD, LD
    • Micah Horvitz, MS, RD
    • Nadia Marzella, MS, RD, LDN
    • Laura Newton, MA, RD, LD
    • Ann-Frances Sutherlin, MS, RD, LD

    Guideline Reviewers

    • Mark L. Britton, Pharm D, mDiv, CDE, BC-ADM, FASHP
    • Catherine Brown, MS, RD, CDE
    • Marion J. Franz, MS, RD, LD, CDE
    • Molly Gee, MEd, RD
    • Nicola D. Guess, MPH, RD
    • Cindy Halstenson, RD, LD, CDE
    • Patricia H. Harper, MS, RD, LDN
    • Arlene Monk, RD, LD, CDE
    • Adam Reppert, MS, RD, LD, CDE
    • Melissa Romano, MS, RD, LDN, CDE
    • Cara E. Walcheck, RD, LD, CDE
    • Hope S. Warshaw, MSc, RD, CDE, BC-ADM

    Academy Staff

    • Deborah Cummins, PhD
    • Kari Kren, MPH, RD
    • Lisa Moloney, MS, RD, LD
    • Paula Ziegler, PhD, RD


     
    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None of the workgroup members listed above disclosed potential conflicts.

     

     

  • Project Resources and Articles
    • Dudzik JM, Senkus KE, Evert AB, Raynor HA, Rozga M, Handu D, Moloney LM. The effectiveness of medical nutrition therapy provided by a dietitian in adults with prediabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2023 Nov;118(5):892-910. doi: 10.1016/j.ajcnut.2023.08.022. Epub 2023 Sep 9. PMID: 37689140.
       
    • Prevention of Type 2 Guideline (2014) Presentation - this 43-slide MS PowerPoint presentation includes all the recommendations and ratings of the guideline. Ideal for use in meetings, in-service presentations and classes (this product is not designed for the consumer). Download for free.
       
  • Prediabetes Systematic Review Project Team and Disclosures (2022-2023)

    The following individuals contributed their valuable time and expertise to this project:

    Content Advisors Members

    • Alison Evert, MS, RD, CDE 
      UW Neighborhood Clinics, Seattle, WA
    • Hollie A. Raynor, PhD, RDN 
      University of Tennessee Knoxville, Department of Nutrition, Knoxville, TN 

    Project Team

    • Lisa Moloney, PhD, RDN, Project Manager  
      Nutrition Researcher Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Mary Rozga, PhD, RDN, Project Manager 
      Nutrition Researcher Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Deepa Handu, PhD, RDN, Methodologist 
      Senior Scientific Director, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Josephine L. Dudzik, MS, RDN, CDN, Lead Analyst 
      PhD candidate, New York University, New York, NY, USA
    • Katelyn E. Senkus, PhD, RDN, Analyst 
      Postdoctoral Associate, University of Alabama (through 08/2023); Baylor College of Medicine (as of 09/2023), Houston, TX, USA
    • Amanda Wanner, MLS, AHIP, Information Specialist 
      Consultant, Saint John, NB, Canada

    Financial Contributors

    • Academy of Nutrition and Dietetics Foundation Evidence Analysis Library Research Endowmen
    • Academy of Nutrition and Dietetics 
      The views or interests of the funding bodies did not influence the development of the systematic review.

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members and content advisors have with companies that sell products or services that are relevant to this topic. Workgroup members and content advisors are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None