Manual of Clinical Nutrition

Medical Nutrition Therapy for Diabetes Mellitus

Manual of Clinical Nutrition Management C- 7 Copyright © 20 13 Compass Group, Inc.

prescription. Consumption of omega-3 fatty acids from fish or from supplements reduces adverse
cardiovascular disease outcomes (2,39). In addition, fish consumption displaces foods that are high in
saturated fat from the diet (2). Two or more servings of fish per week (with the exception of fried fish fillets)
are recommended for persons with diabetes (2,40,41).

Meta-analyses of prospective studies indicate that elevated triglycerides levels are also an independent risk
factor for CHD. The NCEP Adult Treatment Panel III established a classification system and guidelines for
intervention and treatment of hypertriglyceridemia (35). Refer to Section IC: Medical Nutrition Therapy for
Disorders of Lipid Metabolism for the latest recommendations. Table C-2 outlines strategies to treat
disorders of lipid metabolism in patients with diabetes:

Table C-2: Strategies to Treat Disorders of Lipid Metabolism in Patients with Diabetes

Disorders of Lipid Metabolism Goals and Treatment Strategies

Elevated LDL cholesterol levela (>70 mg/dL with

very high CHD risk, >100 mg/dL with high CHD

risk, >130 mg/dL with moderately high CHD

risk) (34)

Goal: decrease serum LDL cholesterol

Therapeutic Lifestyle Changes Diet:

25% to 35% energy from fat

<7% energy from saturated and trans fatb

<200 mg cholesterol per day

Weight reduction and physical activity

High triglycerides level (200-500 mg/dL measured

when blood glucose is in fair or good control) (35)

Goals: decrease LDL cholesterol, decrease

triglycerides

Therapeutic Lifestyle Changes Diet:

25% to 35% energy from fat

<7% energy from saturated and trans fatb

>10% energy from monounsaturated fat

Approximately 50% energy from carbohydrate

Weight reduction and physical activity

Drug therapy

Very high triglycerides level (>500 mg/dL

measured when blood glucose is in fair or good

control) (34)

Goals: decrease triglycerides to prevent acute

pancreatitis and chylomicronemia syndrome,

decrease LDL cholesterol

Diet approach:

<15% energy from all fat

If triglycerides are >1,000 mg/dL, omega-3 fatty

acids may be usedc^ (2,39).

Weight reduction and physical activity

Drug therapy

a Pharmacologic therapy should be initiated as an adjunct to behavioral interventions to achieve a 30% to 40% decrease in LDL
cholesterol from baseline values for moderately high risk, and very high risk patients (34).

b (^) Trans fatty acids increase LDL cholesterol (4). The American Heart Association (2006) recommends <1% of energy from trans fatty
acids.
c (^) See discussion of omega- 3 fatty acids in Section C: Medical Nutrition Therapy for Disorders of Lipid Metabolism.
Hypertension and Sodium
People with diabetes should maintain blood pressure levels less than 130/80 mm Hg (1). People with
diabetes and hypertension should be medically treated to a systolic blood pressure goal of < 140 mm Hg and
a diastolic blood pressure goal < 80 mm Hg (1). Recommendations regarding dietary sodium are the same for
people with diabetes and the general population. Both normotensive and hypertensive individuals should
limit sodium consumption to 2,400 mg/day. For people with hypertension, less than 2,400 mg/day of sodium
is recommended, as well as lifestyle therapy including applying the principles of the Dietary Approaches to
Stop Hypertension Diet, weight reduction if overweight, increasing potassium intake; moderation of alcohol
consumption; and increased physical activity to lower blood pressure as an adjunct to pharmacotherapy (2,42).
For people with hypertension and nephropathy, less than 2,000 mg/day of sodium is recommended (1,2).
(See Section IF: Sodium-Controlled Diets.)