Manual of Clinical Nutrition Management C- 1 Copyright © 20 13 Compass Group, Inc.
MEDICAL NUTRITION THERAPY FOR DIABETES MELLITUS
Description
The goals of medical nutrition therapy for diabetes mellitus are to improve overall metabolic outcomes
(glucose and lipid levels), provide appropriate energy to maintain desirable body weight, and improve overall
health through optimal nutrition (1). The consistent-carbohydrate meal planning approach incorporates
consistent carbohydrate intake, fat intake modifications, and consistent timing of meals and snacks (if
needed). The American Diabetes Association recommends the consistent-carbohydrate meal planning
approach over the standardized energy-level meal patterns based on the exchange lists (1-3).
Indications and Nutrition Diagnosis
Diabetes is diagnosed and classified based on the results of appropriate medical and laboratory tests. After
extensive review of the literature and improved standardization of the assay in 2009, the Expert Committee
on Diagnosis and Classification of Diabetes Mellitus has approved the use of the A1C test for diagnosing
diabetes mellitus (1). An A1C test of > 6.5% is the threshold used to diagnose diabetes mellitus (1). See Section
II: Diagnosis Criteria for Diabetes Mellitus. The classification of diabetes mellitus includes four clinical classes
(1):
type 1 diabetes (caused by beta-cell destruction that usually leads to absolute insulin deficiency)
type 2 diabetes (caused by progressive insulin secretory defect on the background of insulin resistance)
other specific types (due to other causes, eg, genetic defects in beta-cell function, genetic defects in
insulin action, diseases of the exocrine pancreas, or drug or chemical induced)
gestational diabetes mellitus (diabetes mellitus diagnosed during pregnancy)
The type of diabetes and the individual patient’s needs, as presented by the nutrition signs and symptoms,
will determine the nutrition diagnosis, medical nutrition therapy, and approach to self-management training.
The overall goal of nutrition intervention is to assist and facilitate individual lifestyle and behavior changes
that will lead to improved metabolic control (2). The following goals of medical nutrition therapy apply to all
persons with diabetes (2):
Attain and maintain optimal metabolic outcomes including (2):
a) a blood glucose level in the normal range, or as close to the normal range as safely possible, to reduce
the risk of diabetic complications,
b) a lipid and lipoprotein profile that reduces the risk of macrovascular disease, and
c) blood pressure levels that reduce the risk of vascular disease.
Prevent, treat, or delay the development of obesity, dyslipidemia, cardiovascular disease, hypertension,
nephropathy, retinopathy, and neurologic complications associated with diabetes mellitus.
Improve health through healthy food choices and physical activity.
Address individual nutrition needs, taking into consideration the patient’s personal and cultural
preferences and willingness to change.
Maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.
Contribute to normal outcomes of pregnancies for women with preexisting diabetes and gestational
diabetes.
Provide adequate energy and nutrients for increased needs during pregnancy and lactation.
Provide adequate energy to maintain normal growth and development rates in children and adolescents
with diabetes.
Table C-1: Summary of Glycemic Recommendations for Many Non-pregnant Adults With Diabetesa
Biochemical Index Goala
A1C
Preprandial capillary plasma glucose, mg/dL
<7.0%
70 - 130 (3.9-7.2 mmol/L)Peak postprandial capillary plasma glucoseb,
mg/d(mmol/l)
<180 (10.0)
Hemoglobin A1c
aThese goals should be individualized based on duration of diabetes, age, life expectancy, cormorbid conditions, known CVD or advanced
microvascular complications, hypoglycemia unawareness and individual patient considerations. More or less stringent glycemic goals