American Diabetes Association Guide to Nutrition Therapy for Diabetes. Marion J. Franz

15. Nutrition Therapy for Diabetic Kidney Disease

       Madelyn L. Wheeler, MS, RD, CDE, FADA

       16. Nutrition Therapy for Diabetes and Celiac Disease

       Carol Brunzell, RD, CDE

       17. Nutrition Therapy for Cystic Fibrosis–Related Diabetes

       Carol Brunzell, RD, CDE

       18. Nutrition Therapy for Diabetic Gastropathy

       Meghann Moore, MPH, RD, CDE

       19. Nutrition Therapy for Bariatric Surgery and Diabetes

       Margaret Furtado, MS, RD, LDN, and Alison B. Evert, MS, RD, CDE

       Diabetes Nutrition Therapy and Technology

       20. Integrating Nutrition Therapy, Blood Glucose Monitoring, and Continuous Glucose Monitoring

       Margaret A. Powers, PhD, RD, CDE, and Mary M. Austin, MA, RD, CDE, FAADE

       21. Integrating Nutrition Therapy into Insulin Pump Therapy

       Alison B. Evert, MS, RD, CDE

       Diabetes Nutrition Therapy Education

       22. Effective Nutrition Education and Counseling

       Jackie Boucher, MS, RD, CDE

       23. Health Literacy and Numeracy in Diabetes Nutrition Therapy and Self-Management Education

       Marjorie Cypress, PhD, CNP, CDE

       24. Cost-Effectiveness of Diabetes Medical Nutrition Therapy

       Carolyn C. Harrington, RD, CDE

       Nutrition Therapy for Prevention of Diabetes

       25. Nutrition Therapy and Prediabetes

       Gretchen Youssef, MS, RD, CDE

       26. Integrating Nutrition Therapy into Community-Based Diabetes Prevention Programs

       Ann Albright, PhD, RD, and Heather Devlin, MA

Preface/Acknowledgments

      Nutrition therapy is the implementation of evidence-based nutrition recommendations and interventions. As new discoveries in the science of nutrition and diabetes are reported, nutrition therapy, if needed, changes. In 1971, the American Diabetes Association (ADA) published its first report on diabetes nutrition recommendations (ADA 1971). These recommendations have been updated in five position statements (ADA 1979, 1987, 1994, 2002, 2008), technical reviews (Franz 1994, 2002), and a systematic review (Wheeler 2012). A summary of the position statements is also incorporated into the annual ADA Standards of Care. The 1994 recommendations perhaps drew the most attention by the public when they reported that total, not the type of, carbohydrate affected blood glucose levels and sugary foods could be substituted for starchy foods. Additionally, before the 1994 recommendations, all position statements attempted to identify an “ideal” nutrition prescription with ideal percentages of carbohydrate, protein, and fat that would apply to everyone with diabetes. Although the need for individualization was stressed in all prior position papers, nutrition prescriptions, which were commonly given by physicians, for specific calorie levels and/or percentages of macronutrients, really did not allow for much, if any, individualization. The 1994 position statement also recommended that individualized nutrition prescriptions be based on metabolic profiles, treatment goals, and, perhaps most importantly, changes the person with diabetes is willing and able to make.

      The Academy of Nutrition and Dietetics (Acad Nutr Diet, formerly the American Dietetic Association) published its first set of nutrition practice guidelines for type 2 and type 1 diabetes in 1995 and 1998, respectively (Monk 1995; Kulkarni 1998). Both sets of guidelines were field-tested in randomized clinical trials and shown to be effective (Franz 1995; Kulkarni 1998). Updates were published in 2001 and in the Acad Nutr Diet Evidence Analysis Library (American Dietetic Association 2001; Acad Nutr Diet 2008a). The guidelines for nutrition therapy for gestational diabetes were also published and field-tested (Reader 2006) and updated (Acad Nutr Diet 2008b). Nutrition practice guidelines for type 1 and type 2 diabetes in adults also have been updated and published (Franz 2010). Medical nutrition therapy has repeatedly been shown to be effective and essential in the prevention of diabetes and in the management of diabetes and its complications. However, just as there is no one medication or insulin therapy that applies to all people with diabetes, there is no one nutrition therapy intervention that applies to all people with diabetes. A goal of this guide is to assist health care providers in the selection of appropriate individualized nutrition therapy interventions.

      The 1999 American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes served as the basis for this guide. Authors were asked to update the available 1999 chapters by reviewing the evidence published after 1998. If evidence analysis was available in the current reviews by the Acad Nutr Diet and ADA (www.adaevidence; Franz 2010; Acad Nutr Diet 2008), they were asked to briefly summarize this evidence. Chapter authors also conducted a literature search for evidence published after these summaries. Chapters include tables of the new evidence, conclusions from the evidence, and recommendations for integrating diabetes nutrition therapy into the management of diabetes and its complications or for the prevention of diabetes. This guide is intended to serve as a resource for all health care professionals interested in the evidence supporting nutrition therapy interventions, not just for macro- and micronutrients, but for all the related areas of diabetes management in which nutrition therapy is essential.

      It has been an honor and a pleasure to edit this text. We are truly indebted to the talented chapter authors for the thoroughness and thoughtfulness given to writing their chapters. They truly represent the many excellent clinicians and researchers interested in the field of diabetes nutrition. We also thank the reviewers, especially Stephanie Dunbar, Director of Nutrition and Clinical Affairs for the ADA, who directed the review. Special thanks go to Victor Van Beuren, our editor, who kept us on target and committed to the proposed timeline. And, of course, thanks go to the American Diabetes Association for its ongoing recognition of the integral role of nutrition therapy in the treatment of diabetes and its dedication to providing professionals with the latest available evidence.

      Marion J. Franz, MS, RD, CDE

      Alison B. Evert, MS, RD, CDE

      Bibliography

      Academy of Nutrition and Dietetics: Evidence Analysis Library. Available at http://www.adaevidencelibrary.com. Accessed January 2012

      Academy of Nutrition and Dietetics: Diabetes Type 1 and 2 for Adults Evidence-Based Nutrition Practice Guidelines, 2008a. Available at http://www.adaevidencelibrary.com/topic.cfm?=3251. Accessed January 2012

      Academy of Nutrition and Dietetics: Gestational Diabetes Mellitus (GDM) Evidence-Based Nutrition Practice Guidelines, 2008b. Available at http://www.adaevidencelibrary.com/topic.cfm?=3731.