Scientific Report of the 2015 Dietary Guidelines Advisory Committee

Table of Contents

Nutrition Therapy Recommendations for the Management of Adults With Diabetes
Doctor's Note Wait a second. Antenatal and childhood exposure to phthalates has recently been associated with higher childhood BP — but not with the development of overt HTN. Home blood pressure monitoring in paediatric chronic hypertension. If BP is not controlled with a single agent, a second agent can be added to the regimen and titrated as with the initial drug. Bernstein thinks that it is around 4.

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Diabetic diet

Vegetarian arteries dilate four times better than omnivore arteries. But this study excluded smokers completely. The beneficial effects were independent of non-dietary risk factors. In fact, a healthy diet may even trump smoking. The preservation of endothelial function in older Chinese may help explain why they have such low heart attack rates, despite their high prevalence of cigarette smoking.

What we need is an interventional trial. Put people on a plant-based diet and see if their arterial function improves, which is exactly what Dr. Dean Ornish did, showing a significant boost in arterial function compared to control. Is this just some intangible risk factor test result, though, or does it actually have real world implications? Are their arteries naturally dilating so much better that their chest pain actually improves?

This marked reduction in frequency, severity, and duration of angina chest pain was sustained five years later; a long-term reduction in angina is comparable to that of surgery, but without the knife. How about a thousand patients put on a whole-food, plant-based diet. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. Please consider volunteering to help out on the site. Images thanks to Ryan via Flickr.

You may republish this material online or in print under our Creative Commons licence. You must attribute the article to NutritionFacts. Physical activity can acutely increase urinary albumin excretion. However, there is no evidence that vigorous-intensity exercise increases the rate of progression of diabetic kidney disease, and there appears to be no need for specific exercise restrictions for people with diabetic kidney disease in general Advise all patients not to use cigarettes and other tobacco products A or e-cigarettes.

Include smoking cessation counseling and other forms of treatment as a routine component of diabetes care. Results from epidemiological, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks Recent data show tobacco use is higher among adults with chronic conditions Smokers with diabetes and people with diabetes exposed to secondhand smoke have a heightened risk of CVD, premature death, and microvascular complications.

Smoking may have a role in the development of type 2 diabetes , The routine and thorough assessment of tobacco use is essential to prevent smoking or encourage cessation.

Numerous large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of brief counseling in smoking cessation, including the use of telephone quit lines, in reducing tobacco use. For the patient motivated to quit, the addition of pharmacologic therapy to counseling is more effective than either treatment alone Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse Although some patients may gain weight in the period shortly after smoking cessation , recent research has demonstrated that this weight gain does not diminish the substantial CVD benefit realized from smoking cessation One study in smokers with newly diagnosed type 2 diabetes found that smoking cessation was associated with amelioration of metabolic parameters and reduced blood pressure and albuminuria at 1 year Nonsmokers should be advised not to use e-cigarettes.

There are no rigorous studies that have demonstrated that e-cigarettes are a healthier alternative to smoking or that e-cigarettes can facilitate smoking cessation. More extensive research of their short- and long-term effects is needed to determine their safety and their cardiopulmonary effects in comparison with smoking and standard approaches to smoking cessation — Psychosocial care should be integrated with a collaborative, patient-centered approach and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life.

Psychosocial screening and follow-up may include, but are not limited to, attitudes about diabetes, expectations for medical management and outcomes, affect or mood, general and diabetes-related quality of life, available resources financial, social, and emotional , and psychiatric history.

Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating, and cognitive capacities using patient-appropriate standardized and validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance.

Including caregivers and family members in this assessment is recommended. Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life. Emotional well-being is an important part of diabetes care and self-management.

There are opportunities for the clinician to routinely assess psychosocial status in a timely and efficient manner for referral to appropriate services. A systematic review and meta-analysis showed that psychosocial interventions modestly but significantly improved A1C standardized mean difference —0.

However, there was a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes. Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, or when problems with glucose control, quality of life, or self-management are identified 1.

Patients are likely to exhibit psychological vulnerability at diagnosis, when their medical status changes e. Providers can start with informal verbal inquires, for example, by asking if there have been changes in mood during the past 2 weeks or since their last visit.

Providers should consider asking if there are new or different barriers to treatment and self-management, such as feeling overwhelmed or stressed by diabetes or other life stressors. Standardized and validated tools for psychosocial monitoring and assessment can also be used by providers , with positive findings leading to referral to a mental health provider specializing in diabetes for comprehensive evaluation, diagnosis, and treatment.

Diabetes distress DD is very common and is distinct from other psychological disorders — The constant behavioral demands medication dosing, frequency, and titration; monitoring blood glucose, food intake, eating patterns, and physical activity of diabetes self-management and the potential or actuality of disease progression are directly associated with reports of DD High levels of DD significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and poorer dietary and exercise behaviors 16 , , It may be helpful to provide counseling regarding expected diabetes-related versus generalized psychological distress at diagnosis and when disease state or treatment changes DD should be routinely monitored using patient-appropriate validated measures If DD is identified, the person should be referred for specific diabetes education to address areas of diabetes self-care that are most relevant to the patient and impact clinical management.

People whose self-care remains impaired after tailored diabetes education should be referred by their care team to a behavioral health provider for evaluation and treatment.

Other psychosocial issues known to affect self-management and health outcomes include attitudes about the illness, expectations for medical management and outcomes, available resources financial, social, and emotional , and psychiatric history. Indications for referral to a mental health specialist familiar with diabetes management may include positive screening for overall stress related to work-life balance, DD, diabetes management difficulties, depression, anxiety, disordered eating, and cognitive dysfunction see Table 4.

It is preferable to incorporate psychosocial assessment and treatment into routine care rather than waiting for a specific problem or deterioration in metabolic or psychological status to occur 25 , Providers should identify behavioral and mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, to whom they can refer patients. Ideally, psychosocial care providers should be embedded in diabetes care settings.

Although the clinician may not feel qualified to treat psychological problems , optimizing the patient-provider relationship as a foundation may increase the likelihood of the patient accepting referral for other services.

Collaborative care interventions and a team approach have demonstrated efficacy in diabetes self-management and psychosocial functioning Situations that warrant referral of a person with diabetes to a mental health provider for evaluation and treatment. Standards of Medical Care in Diabetes— Diabetes Care ;41 Suppl. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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We do not capture any email address. Skip to main content. Diabetes Care Jan; 41 Supplement 1: B There are four critical times to evaluate the need for diabetes self-management education and support: E Facilitating appropriate diabetes self-management and improving clinical outcomes, health status, and quality of life are key goals of diabetes self-management education and support to be measured and monitored as part of routine care.

C Effective diabetes self-management education and support should be patient centered, may be given in group or individual settings or using technology, and should help guide clinical decisions.

A Because diabetes self-management education and support can improve outcomes and reduce costs B , adequate reimbursement by third-party payers is recommended. E DSMES services facilitate the knowledge, skills, and abilities necessary for optimal diabetes self-care and incorporate the needs, goals, and life experiences of the person with diabetes. At diagnosis Annually for assessment of education, nutrition, and emotional needs When new complicating factors health conditions, physical limitations, emotional factors, or basic living needs arise that influence self-management When transitions in care occur DSMES focuses on supporting patient empowerment by providing people with diabetes the tools to make informed self-management decisions 5.

Evidence for the Benefits Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors 7 , lower A1C 6 , 8 — 10 , lower self-reported weight 11 , 12 , improved quality of life 9 , 13 , reduced all-cause mortality risk 14 , healthy coping 15 , 16 , and reduced health care costs 17 — View inline View popup. Goals of Nutrition Therapy for Adults With Diabetes To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and: Eating Patterns, Macronutrient Distribution, and Meal Planning Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes.

Weight Management Management and reduction of weight is important for overweight and obese people with type 1 and type 2 diabetes. Carbohydrates Studies examining the ideal amount of carbohydrate intake for people with diabetes are inconclusive, although monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose control 70 , Protein There is no evidence that adjusting the daily level of protein intake typically 1—1.

Fats The ideal amount of dietary fat for individuals with diabetes is controversial. Micronutrients and Supplements There continues to be no clear evidence of benefit from herbal or nonherbal i. Alcohol Moderate alcohol intake does not have major detrimental effects on long-term blood glucose control in people with diabetes. Nonnutritive Sweeteners For some people with diabetes who are accustomed to sugar-sweetened products, nonnutritive sweeteners containing few or no calories may be an acceptable substitute for nutritive sweeteners those containing calories such as sugar, honey, agave syrup when consumed in moderation.

C Physical activity is a general term that includes all movement that increases energy use and is an important part of the diabetes management plan. Exercise and Children All children, including children with diabetes or prediabetes, should be encouraged to engage in regular physical activity. Frequency and Type of Physical Activity People with diabetes should perform aerobic and resistance exercise regularly Physical Activity and Glycemic Control Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes Exercise in the Presence of Specific Long-term Complications of Diabetes Retinopathy If proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy is present, then vigorous-intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering vitreous hemorrhage or retinal detachment Peripheral Neuropathy Decreased pain sensation and a higher pain threshold in the extremities result in an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise.

Autonomic Neuropathy Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia Diabetic Kidney Disease Physical activity can acutely increase urinary albumin excretion.

E Include smoking cessation counseling and other forms of treatment as a routine component of diabetes care. B Results from epidemiological, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks A Psychosocial screening and follow-up may include, but are not limited to, attitudes about diabetes, expectations for medical management and outcomes, affect or mood, general and diabetes-related quality of life, available resources financial, social, and emotional , and psychiatric history.

E Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating, and cognitive capacities using patient-appropriate standardized and validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Screening Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, or when problems with glucose control, quality of life, or self-management are identified 1.

B Diabetes distress DD is very common and is distinct from other psychological disorders — Referral to a Mental Health Specialist Indications for referral to a mental health specialist familiar with diabetes management may include positive screening for overall stress related to work-life balance, DD, diabetes management difficulties, depression, anxiety, disordered eating, and cognitive dysfunction see Table 4.

Diabetes self-management education and support in type 2 diabetes: Diabetes Care ; Clin Diabetes ; Patient Educ Couns ; Twenty-first century behavioral medicine: Self-management education for adults with type 2 diabetes: National standards for diabetes self-management education and support. Diabetes Care ; 37 Suppl. Evaluation of a behavior support intervention for patients with poorly controlled diabetes.

Arch Intern Med ; Structured type 1 diabetes education delivered within routine care: Diabetes self-management education for adults with type 2 diabetes mellitus: Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus.

A systematic review with meta-analysis. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev ; 2: Cochran J , Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ ; Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: Endocrine ; Facilitating healthy coping in patients with diabetes: Nutritionist visits, diabetes classes, and hospitalization rates and charges: Assessing the value of the diabetes educator.

One-year outcomes of diabetes self-management training among Medicare beneficiaries newly diagnosed with diabetes. Med Care ; A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev ;3: Ann Intern Med ; A systematic review of diabetes self-care interventions for older, African American, or Latino adults.

Peyrot M , Rubin RR. Behavioral and psychosocial interventions in diabetes: Comparative effectiveness of goal setting in diabetes mellitus group clinics: Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev ; 1: Internet delivered diabetes self-management education: Diabetes Technol Ther ; Long-term outcomes of a Web-based diabetes prevention program: J Med Internet Res ; A systematic review of reviews evaluating technology-enabled diabetes self-management education and support.

J Diabetes Sci Technol ; The role of community health workers in diabetes: Curr Diab Rep ; Diabetes control with reciprocal peer support versus nurse care management: Peer mentoring and financial incentives to improve glucose control in African American veterans: Self-management education programmes by lay leaders for people with chronic conditions.

Cochrane Database Syst Rev ; 4: Assessing the value of diabetes education. Associations between self-management education and comprehensive diabetes clinical care. Diabetes Spectr ; Health Educ Behav ; Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes--United States, Reasons why patients referred to diabetes education programmes choose not to attend: Diabet Med ; Reconsidering cost-sharing for diabetes self-management education: Accessed 25 September Management of hyperglycemia in type 2 diabetes, Nutrition therapy recommendations for the management of adults with diabetes.

Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc ; Effect of carbohydrate counting and medical nutritional therapy on glycaemic control in type 1 diabetic subjects: Academy of Nutrition and Dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults: J Acad Nutr Diet ; Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS For further context, check out my associated blog posts: By subscribing, you will automatically receive the latest videos emailed to you or downloaded to your computer or portable device.

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