Setting the Stage for Good Nutrition in Diabetes

This Physician’s Weekly feature covering nutritional recommendations and interventions for diabetes was completed in cooperation with the experts at the American Diabetes Association.  Medical nutrition therapy (MNT) is an important part of preventing prediabetes and diabetes, managing existing diabetes, and preventing or slowing the rate of the development of diabetes complications. MNT is also an integral component of diabetes self-management education and training. The goals of MNT are to achieve and maintain healthy A1C, blood pressure, and cholesterol levels by modifying the intake of nutrients and improving lifestyle behaviors. “The United States has about 57 million people with pre-diabetes, and most of these people have problems with being overweight and obese,” says Wahida Karmally, DrPH, RD, CDE, CLS, FNLA. “In addition, people with diagnosed diabetes are often already overweight or obese. Using MNT and increasing physical activity are paramount to managing these individuals.” Clinical practice recommendations on MNT, which are based on scientific evidence, have recently been updated by the American Diabetes Association. Available at, the recommendations can assist clinicians as they provide MNT to patients and offer strategies for specific patient groups (Table 1). “With MNT, it’s important to address individual nutrition needs,” says Dr. Karmally. “That requires taking into account personal and cultural preferences as well as willingness to change. Another goal is to help people maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.” Assessing the Evidence Clinical trials and outcome studies of MNT have reported decreases in A1C of about 1% in type 1 diabetes and 1% to 2% in type 2 diabetes, depending on the duration of...