Although nutrition therapy is pivotal in the management of patients with diabetes or prediabetes, there’s no one correct eating pattern appropriate for all patients, according to a consensus report from an expert panel convened by the American Diabetes Association.
A one-size-fits-all eating plan would be an unrealistic expectation, given the diversity of cultural issues, personal preferences, comorbidities, and other factors that are unique to individual patients with diabetes or prediabetes, according to the report, which was published in Diabetes Care.
Instead, authors of the report outlined nine different eating patterns, along with the evidence supporting their use and their reported benefits in patients with diabetes or prediabetes.
The report reflects a commitment to developing evidence-based guidelines that are “achievable and meet people where they are” to formulate individualized nutrition plans, William T. Cefalu, MD, chief scientific, medical, and mission officer for the ADA, said in a statement.
“The importance of this consensus also lies in the fact it was authored by a group of experts who are extremely knowledgeable about numerous eating patterns, including vegan, vegetarian, and low carb,” Dr. Cefalu added.
The expert panel of 14 individuals included registered dietitians, diabetes educators, endocrinologists, a primary care physician, and a patient advocate who all answered a national call for experts, according to the ADA.
The panel reviewed more than 600 nutrition manuscripts published between 2014 and 2018 to develop the new consensus statement, which updates the ADA 2014 position statement on nutrition therapy for adults with diabetes and has been incorporated into the association’s Standards of Medical Care in Diabetes–2019 supplement as a living standards update.
All adults with type 1 or 2 diabetes should be referred to individualized, diabetes-focused medical nutrition therapy, the panel members wrote in their report.
There is no evidence suggesting an ideal percentage of calories from carbohydrate, protein, and fat in patients with prediabetes or diabetes, so macronutrient distribution should also be individualized, according to the panel.
Likewise, a variety of eating patterns are acceptable for managing diabetes, according to the report, which describes evidence for eating patterns including Mediterranean, vegetarian or vegan, low fat and very low fat, low carbohydrate and very low carbohydrate, and paleo, as well as the Dietary Approaches to Stop Hypertension diet and the Department of Agriculture Dietary Guidelines for Americans.
Not all diets have the same level of evidence, however. For prevention of prediabetes or type 2 diabetes, for example, the most robust research is available for Mediterranean-style, low-fat, and low-carbohydrate eating patterns, the panel said.
Until there’s better comparative evidence between eating patterns, health care providers should concentrate on several key factors common to a number of the eating patterns, such as limiting sugars and refined grains, emphasizing nonstarchy vegetables, and choosing whole foods over processed foods, the experts wrote.
Consensus panel participants reported disclosures with the ADA, the National Institutes of Health, the Academy of Nutrition and Dietetics, the American Medical Group Association, the University of Michigan, Novo Nordisk, Merck, Amgen, Gilead, BOYDSense, Janssen, Sanofi, Pfizer, Sunstar Foundation, New England Dairy and Dairy Farmer, the National Dairy Council, Kowa Company, and dietdoctor.com.
SOURCE: Evert AB et al. Diabetes Care. 2019 Apr 18. doi: 10.2337/dci19-0014.