Diabetes dietary recommendations of american association of clinical endocrinologists

Nutrition and Diabetes

1. MNT (medical nutrition therapy) is an essential component of any comprehensive diabetes mellitus management program (grade A).

2. Meal composition affects glycemic control and cardiovascular risk (grade A).

3. Tailor a diet for individual patients based on current weight, medication regimen, food preferences, lifestyle, and lipid profile (grade A).

4. No specific diet is endorsed by ACE/AACE for people with diabetes mellitus (grade D).

5. Total dietary carbohydrates should represent 45% to 65% of daily energy intake unless otherwise indicated (grade D).

6. Protein intake should be the same as for patients who do not have diabetes mellitus: 15% to 20% of daily energy intake (grade D).

7. Fiber should be consumed in amounts of 25 to 50 g/d or 15 to 25 g/1000 kcal ingested (grade A).

8. Total dietary fat should generally comprise less than 30% of daily energy intake (grade D):

9. Dietary monounsaturated fatty acids and n-3 polyunsaturated fatty acids have beneficial effects on the lipid profile and should comprise most fat intake (grade B).

10. Dietary saturated fat should be limited to less than 10% of daily energy intake with less than 300 mg/d of cholesterol (grade A).

11. If the patient's LDL-C level is greater than 100 mg/dL, consumption of saturated fat should be limited to less than 7% of daily energy intake, and cholesterol should be limited to less than 200 mg/d (grade A).

12. Trans-fat intake should be minimized, or preferably, eliminated (grade D).

13. Basal-bolus insulin therapy using insulin analogs or continuous subcutaneous insulin infusion in conjunction with carbohydrate counting is the most physiologic treatment and provides the greatest flexibility in terms of food choices and timing of meals (grade B).

14. Basal-bolus therapy using a consistent carbohydrate meal plan can be equally effective for patients unable or unwilling to count carbohydrates (grade D).

15. Instruct patients who choose to consume alcohol to limit intake to 1 drink per day for women and 2 drinks per day for men (grade D).

16. Secondary prevention strategies for T2DM in individuals with impaired glucose regulation include a controlled-energy diet, exercise, and weight loss (grade A).

Clinical Considerations

All Patients With Diabetes Mellitus Carbohydrate absorption may be altered by other foods in a mixed meal. For example, fat and fiber delay the absorption of carbohydrates and blunt the glycemic response. Terms such as simple sugars and complex carbohydrates have recently been abandoned since it is now recognized that their effects on blood glucose are similar. Sucrose does not need to be avoided by patients with diabetes mellitus, but when it is consumed, it should replace other carbohydrates in the diet.