New Consensus Report Recommends Individualized Eating Plan

Food Nutrition
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New Consensus Report Recommends Individualized Eating Plan
to Meet Each Person’s Goals, Life Circumstances and Health Status

Updates 2014 ADA report and includes nutrition guidance for optimal weight management, on reducing carbohydrates and managing macronutrient intake and examines a variety of eating patterns

ARLINGTON, Va. (April 18, 2019) — Personalized nutrition plans, nutrition for optimal weight management, and the prevention and management of diabetes complications including cardiovascular and kidney disease and gastroparesis, are detailed in the new guidance document, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report (Consensus Report), produced by a panel of experts assembled by the American Diabetes Association (ADA) . The Consensus Report is published online today, April 18, 2019, at 1:00 p.m. ET in Diabetes Care , the ADA’s flagship clinical research journal.

The Consensus Report was produced by a national panel of 14 distinguished professionals with diverse scientific, clinical and nutrition expertise. The group included registered dietitian nutritionists, certified diabetes educators, endocrinologists, a primary care physician and a patient advocate, who answered a national call for experts. Nine additional peer experts in diabetes and the ADA’s Professional Practice Committee reviewed the Consensus Report. The Consensus Report panel performed a comprehensive review of more than 600 key nutrition manuscripts published from 2014 through 2018. The resulting recommendations focus on key areas of nutrition management and guidelines to achieve optimal diabetes management, reduce complications, and improve quality of life for adults with type 1 or type 2 diabetes or prediabetes. This Consensus Report is an update to the ADA’s 2014 Position Statement on nutrition therapy for adults with diabetes and is incorporated today, simultaneously, into the ADA’s Standards of Medical Care in Diabetes—2019 as a Living Standards Update.

New guidelines and highlights in the report include:

  • The Consensus Report panel emphasizes that there is not one, single recommended nutrition plan for all people with diabetes given the broad spectrum of people affected by diabetes and prediabetes, as well as other factors, such as cultural preferences, food availability and socioeconomic factors.

  • Evidence suggests there is no ideal percentage of calories from carbohydrate, protein and fat for all people with diabetes or at-risk for diabetes, and a variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes and prediabetes.

  • Macronutrient distribution should be personalized based on individualized assessment of current eating patterns, preferences and metabolic goals.

  • Prior to this Consensus Report, the presence of obesity in type 1 diabetes was not specifically addressed. The panel determined that similar to type 2 diabetes, the presence of obesity with type 1 diabetes can worsen insulin resistance, glycemic variability, microvascular disease complications and cardiovascular risk factors. Therefore, weight management has been recommended as an essential component of care for people with type 1 diabetes who have overweight or obesity.

  • For purposes of weight loss, the ability to maintain and sustain an eating plan that results in an energy deficit, irrespective of macronutrient composition or eating pattern, is critical for success.

  • A comprehensive “Table on Eating Patterns Reviewed” graphic (Table 3) summarizes various types of eating patterns and the benefits reported. The panel notes that studies comparing the same two or more eating patterns could easily differ in the investigators’ definition of the patterns, the effectiveness of the research team in fostering pattern adherence among study participants, the accuracy of assessing pattern adherence, study duration and participant population characteristics. Overall, few long-term (2 years or longer) randomized trials have been conducted of any of the dietary patterns in any of the conditions examined.

  • An important distinction made by the consensus group was that until there is convincing and scientifically validated evidence surrounding comparative benefits of different eating patterns in specific individuals, health care providers should focus on the key factors that are common among the patterns. These key factors include an emphasis on non-starchy vegetables, minimizing added sugars and refined grains, and choosing whole, unprocessed foods over processed foods to the extent possible.

  • Replace sugar-sweetened beverages (SSBs) with water as often as possible. Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy.

  • In general, replacing saturated fat with unsaturated fats reduces both total cholesterol and LDL-C and also decreases cardiovascular disease (CVD) risk.

  • Research indicates medical nutrition therapy for adults with type 2 diabetes can result in hemoglobin A1c (A1C) reductions that can be similar to or greater than what could be expected with treatment using currently available medications.

  • Also notable is the addition of critical information on the integral role nutrition therapy plays in the prevention and management of diabetes complications, including CVD, diabetes kidney disease and gastroparesis.

  • The importance of referring adults living with type 1 or type 2 diabetes to individualized, diabetes-focused medical nutrition therapy (MNT) upon diagnosis and as needed throughout their life span is addressed, considering that national data indicates most people with diabetes do not receive any nutrition therapy or formal diabetes education.

  • Additional emphasis is placed on coordinating and aligning the MNT plan with the overall management strategy, including use of medications and physical activity, on an ongoing basis.

Nutritional interventions and considerations for adults diagnosed with prediabetes are included in the recommendations for the first time. Additional key messages include:

  • People with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program and/or an individualized nutrition plan with the goals of improving eating habits, increasing moderate-intensity physical activity to at least 150 min per week, and achieving and maintaining 7–10% loss of initial body weight, if needed.

  • When health care providers, including RDNs and diabetes educators, are counseling individuals with diabetes and prediabetes about weight management, they should give special attention to prevent, diagnose and treat disordered eating.

  • The Consensus Report panel found that studies using personalized nutrition approaches to examine genetic, metabolomic and microbiome variations (gut health/microbiome) have not yet identified specific factors that consistently improve outcomes in type 1 diabetes, type 2 diabetes or prediabetes.

“‘What can I eat?’ is the number one question asked by people with diabetes and prediabetes when diagnosed. This new Consensus Report reflects the ADA’s continued commitment to evidence-based guidelines that are achievable and meet people where they are and recommends an individualized nutrition plan for every person with diabetes or prediabetes,” said the ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD. “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.”

“As detailed by the latest evidence, there is no one, single nutrition plan to be recommended for every person with diabetes due to the broad variability of diabetes for each individual, as well as other life factors such as cultural backgrounds, personal preferences, other health conditions, access to healthy foods and socioeconomic status. The ADA strongly encourages an individualized approach that includes regular review of nutrition status for all people living with diabetes. Reassessment of an individual’s nutritional plan is particularly important during significant life and health status changes, and includes nutrition counseling and guidance to achieve overall improved health and wellness that supports appropriate weight management, reducing diabetes complications and improving quality of life. Working with a team of health providers including a registered dietitian or certified diabetes educator is fundamental to effectively managing diabetes and prediabetes,” concluded Dr. Cefalu.

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With today’s available technologies and frequent lifestyle changes, it seems to me that any “plan” is next to useless as there are just too many daily variables for each individual at any given time of year. Hopefully as the cost and availability and accuracy of CGM’s continue to improve, each diabetic will be trained to Eat, Dose, and Exercise to their meter and their scale for weight rather than try to stick to any plan which is most likely to fail over a period of time.

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In other words, YDMV takes on new meaning here - Your Diet May Vary.

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Not all have the use of a CGM, they are not accessible to blind and low vision people with diabetes. Nancy50

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I have never seen anywhere that diabetics that are blind or have low vision are banned from acquiring a CGM. Can you point to a reference? There has been one or more posts on this forum that there is an app to send the CGM information to a phone or watch that verbally announces blood sugar level every 5 minutes. What are the blind/low vision diabetics using now that is better?

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They cannot use them independently as they are touch screens. .Nancy50

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Some use the freestyle Libre , Many do not have the funding for fancy i phones. National blind groups are trying to get better access to medical devices they can use. Nancy50

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A working link to the report

slowly, slowly, catch the monkey, Soon it will be LCHF Keto :grinning:

Eating patterns that replace certain carbohydrate
foods with those higher in
total fat, however, have demonstrated
greater improvements in glycemia and
certain CVD risk factors (serum HDL cholesterol
[HDL-C] and triglycerides) compared
with lower fat diets. The types or
quality of fats in the eating plans may
influence CVD outcomes beyond the total
amount of fat.

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I am legally blind but not from diabetes. I’ve had retinitis pigmentosa for many years. Could never understand why they don’t make a talking blood tester or pump as an option. I imagine that today’s technology and miniaturization makes it possible. Remember discussing that with the Animas sales person. He just shrugged.

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Yes,Willow4 ,I agree I have retinopathy of prematurity . Advocacy by blind groups is trying to get this to change. Nancy50

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No one is “banned” from acquiring a CGM. However, accessibility is a huge problem for people who are blind or have low vision. I’m legally blind since birth and my endocrinologist held off recommending a pump for years because he felt I wouldn’t be able to use one safely. I was able to memorize the pump menu layout and count button presses. Newer pumps coming out with more complex cartridge filling procedures, smaller fonts, touchscreens, and randomized button presses to unlock the pump are less accessible than pumps of a generation ago (which were already not accessible). CGM receivers are totally inaccessible. If someone has an iPhone, then the Dexcom and LibreLink apps are accessible as far as checking current blood glucose and trend arrows and (for the Dexcom) the alarms. Beyond that, if you want to examine trend graphs or patterns or anything like that, you are out of luck. Virtually all diabetes software and apps are inaccessible, virtually all glucose meters are inaccessible, pens are accessible as long as you ignore the fact that manufacturers state in the information that comes with them that people with insufficient vision shouldn’t use them, and as long as you don’t care about double-checking your dose before injecting or using any of the new memory or Bluetooth features that some pens have. Manufacturers continue to largely ignore the entire issue of accessibility despite 20-30 years of advocacy and technological development and the fact that diabetes is a leading cause of visual impairment.

I’m not aware of any studies on CGM accessibility to date, but here are some on insulin pump accessibility for people who are blind or have low vision:

https://www.researchgate.net/publication/8101809_Accessibility_of_Insulin_Pumps_for_Blind_and_Visually_Impaired_People

https://journals.sagepub.com/doi/full/10.1177/1932296816666536

There are many more studies out there…there is just what I came across with some quick Google searches, not diving into any journal databases.

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Thank you so kindly for your information, the more educated we are, the more we can advocate for people with additional impairments beyond diabetes. I really appreciate you taking the time to pass along this educational material. I misinterpreted Nancy50’s original post - Sorry

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There are talking blood glucose meters. I don’t have one, but have seen them advertised.

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@Jen I have a Dexcom G6 and an iphone and I can ask Siri for my CGM level. I just say " Hey Siri what is my blood glucose" and she answers and I don’t have to press any buttons. It’s under the Siri settings in the phone.

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There are blood glucose meters that have the result spoken aloud. But there are very few that speak any more information than that. There is one meter in the USA (Prodigy Voice) that I know of that provides access to more than just the current glucose reading, such as the ability to review history or averages.

Here in Canada, the only talking meter available is one called the Oracle. It reads the results of your blood glucose when you test. But there is no way to review the test history or change the settings or do anything else. While testing, error messages are sometimes spoken, but sometimes not, so you may not even be able to tell what went wrong during a test.

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My recollection is that the talking meter wasn’t very accurate either.

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I am not sure if my G5 app has this feature. I don’t think it does. It sounds like it could be a great feature for when driving!

Most people don’t realize that someone who is totally blind can use all the features of devices like an iPhone or a computer because they come with built-in accessibility options. So people with visual impairments can use things like the touchscreen and keyboard just as well as a sighted person, and the accessibility options provide magnification or speech or braille output and navigational option to replace something that someone may not be able to use well, such as the mouse. App and website developers just need to remember to built their products with accessibility in mind. It is slooooowly getting better, but still a long, long road ahead.

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Yes, this is true. People who were fully sighted gave the Prodigy line of meters terrible reviews (you can search this site to see some of them). But for people who need a talking meter, they didn’t have any other choice, so they’d pick an inaccurate meter over nothing.

When I participate in discussions with other people who are blind and visually impaired about Type 1 diabetes, it’s like being in a different world. No one cares about the latest Bluetooth meter or the latest pump technology or open-source software. They just care about whether they can do the bare minimum basics of testing blood sugar, delivering a standard bolus, changing a cartridge, and knowing if an important error message has appeared.

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Thank you,Jen for posting this information. It is so important that everyone with diabetes be aware of this as blindness can happen at any time. Thank you very much. Nancy50