Manual of Clinical Nutrition

Diabetes Mellitus

Manual of Clinical Nutrition Management III- 22 Copyright © 2013 Compass Group, Inc.

For medical nutrition therapy approaches, see “Medical Nutrition Therapy for Diabetes Mellitus” in Section IC.

Routine Monitoring (outcome assessment parameters) (1):
Body weight
Food records
Blood pressure
Self-monitoring of blood glucose (SMBG) records
Self-monitoring of blood glucose (SMBG) should be carried out three or more times daily for
patients using multiple insulin injections or insulin pump therapy (1).
Fasting lipid profile
For most adults with diabetes evaluate annually (1).
Glycated hemoglobin,* also referred to as A1C test
Perform A1C test twice per year in stable patients meeting treatment goals. Assess quarterly in
patients whose therapy has changed, or are not meeting goals (1).
Serum creatinine
Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of
urine albumin excretion. The serum creatinine should be used to estimate glomerular filtration
rate (eGFR) and stage the level of chronic kidney disease (CKD) (1).
Urine (ketones, glucose [except with GDM], protein
Annual screening for microalbuminuria, with random spot urine sample for microalbumin or
urine albumin-to-creatinine ratio (UACR) should be initiated annually in type 1 diabetes and
type 2 diabetes who have been diagnosed for 5 years or more (1).

*Values in the reference range are different for HbA 1 vs HbA1c (2).

Education and self-management training as appropriate: See “Diabetes Nutrition Management: Meal
Planning Approaches” in Section IC: “Medical Nutrition Therapy for Diabetes Mellitus” for discussion of
teaching materials to use with various meal planning approaches. Also refer to Morrison Nutrition Practice
Guideline – Diabetes Mellitus (Uncontrolled and Complications) (4) and Morrison Nutrition Practice Guideline

• Gestational Diabetes Mellitus (5) for acute care; and Type 1 and Type 2 Diabetes Mellitus evidence based
  nutrition practice guidelines for adults in the Academy’s Evidence Analysis Library (6).

References

1. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 20102013;36(suppl 1):11S-66S.


2. Santiago J. Lessons from the Diabetes Control and Complications Trial. Diabetes Care. 1993;42:1549.


3. American Diabetes Association. Nutrition recommendations and interventions for diabetes. Diabetes Care. 2008;31(suppl 1): 61S-
   78S.


4. Morrison Nutrition Practice Guideline – Diabetes Mellitus (Uncontrolled and Complications). In: Inman-Felton A, Smith K, eds.
   Morrison Nutrition Practice Guidelines. Atlanta, Ga: Morrison Management Specialists; 2012. Available at:
   http://www.morrisontoday.com/Documents/Nutrition/MHFS Nutrition.


5. Morrison Nutrition Practice Guideline – Gestational Diabetes Mellitus. In: Inman-Felton A, Smith K, eds. Morrison Nutrition Practice
   Guidelines. Atlanta, Ga: Morrison Management Specialists; 2012. Available at:
   http://www.morrisontoday.com/Documents/Nutrition/MHFS Nutrition.


6. Type 1 and Type 2 Diabetes Evidence-Based Nutrition Practice Guideline for Adults. The Academy of Nutrition and Dietetics, 2008.
   In: The Academy of Nutrition and Dietetics Evidence Analysis Library at http://www.andevidencelibrary.com. Accessed February
   5, 2013.

Bibliography
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(suppl 1): S67-S74.
American Diabetes Association. Nephropathy in diabetes: position statement. Diabetes Care. 2004;27(suppl 1):79S-83S.
American Diabetes Association. Gestational diabetes mellitus: position statement. Diabetes Care. 2004;27(suppl 1):88S-90S.
American Diabetes Association. Hypertension management in adults with diabetes: position statement. Diabetes Care. 2004; 27(suppl
1):65S-67S.