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A Journal on Internal Medicine

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Minerva Medica 2004 April;95(2):115-24

language: English

Prioritizing diabetes nutrition recommendations based on evidence

Franz M. J.


Recommendations for carbohydrate, protein, dietary fat, micronutrients, and alcohol are classified according the level of available evid-ence based on the American Diabetes Association evidence grading system. The grading of recommendations can be used to prioritize nutrition care as those graded A are the most robust and can be emphasized first. Strong evidence suggests that the total amount of carbohydrate in meals (or snacks) is more important than the source or type. All persons with diabetes can benefit from basic information concerning carbohydrate foods, portion sizes, and amounts to select for meals. Patients on intensive (physiological) insulin therapy or insulin pumps can adjust their bolus insulin according to the amount of carbohydrate they plan to ingest. Therefore, the first priority is to identify a food/meal plan that can be used to integrate an insulin regimen into the person's lifestyle. Nutrition therapy for type 2 diabetes progresses from prevention of obesity or weight gain to improving insulin resistance to contributing to improved metabolic control. Research supports nutrition therapy as an effective therapy in reaching treatment goals for glycemia, lipids, and blood pressure. Monitoring of outcomes is essential to assess the outcomes of lifestyle interventions and/or to determine if changes in medication(s) are necessary.

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