Medical Nutrition Therapy Options
for Adults Living with Diabetes
Jane Eyre Schuster, RD, LD, CDE
Legacy Health Diabetes and Nutrition Services
Objectives• Discuss Medical Nutrition Therapy considerations in the treatment
of adults living with type 2 diabetes
• Compare and contrast various eating patterns used in the
treatment for diabetes
Disclosures
I, Jane Eyre Schuster, RD, LD, CDE have no relevant financial or
nonfinancial relationships in the products or services described,
reviewed, evaluated or compared in this presentation.
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Diabetes Self-Management Education and Support Services
▪ Patient centered care
▪ Evidence-based
▪ Individualized to meet the needs of the person, including language
and culture
▪ Delivered by trained and competent individuals (educators) who
are quality assured
▪ Delivered in group or individual settings
▪ Supports the person and their family in developing attitudes,
beliefs, knowledge, and skills to self-manage diabetes
▪ Available to patients at critical times (i.e., at diagnosis, annually,
when complications arise, and when transitions occur)
▪ Includes monitoring of patient progress, including health status,
quality of life
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Medical Nutrition Therapy (MNT)▪ To help people adopt heathy eating patterns
▪ To help manage good blood glucose and cardiovascular risk to
reduce common diabetes related complications
▪ To help preserve quality of life and the pleasure of food
▪ No “one” right way optimize carbohydrates, proteins or fats
▪ Focus on individualized eating plans with foods shown to have
health benefits
▪ Avoid foods that have established harm
▪ Involves comprehensive nutrition assessment with consideration
of comorbidities
▪ Assesses and aids in designing individualized meal patterns that
include food preferences, food allergies, eating habits and
cultural background
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Diabetes Dietitian Intervention
▪ Effects of food on blood glucose levels
▪ Carbohydrate, protein and fat sources
▪ Individualized meal planning
▪ Resources for making healthy food choices
▪ Understand portion sizes
▪ Navigate food label reading
▪ Plan and prepare meals
▪ Best times to eat to match their diabetes medications
▪ Able to address additional nutritionally related issues – Renal,
CVD, HTN, Lipids, Cancer, GI issues, etc
▪ Ongoing nutrition requirements over the lifetime
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Eating Patterns – Which is best?
▪ Mediterranean
▪ Dash (Dietary Approaches to Stop Hypertension )
▪ Low Carbohydrate
▪ Low Glycemic Index
▪ High Protein
▪ Carbohydrate Controlled
▪ Low Fat
▪ Nonsurgical Energy restriction for weight loss – Meal
Replacements
▪ Surgical Weight loss intervention
▪ ???
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Mediterranean Diet
Pros Cons
includes fruits, vegetables, whole
grains, beans, moderate intake of
wine and lean meats and low intake
of processed foods
Does not state exact servings
amounts/day, rather the macronutrient
distribution
Promotes heart health Uses terms like: “low to moderate intake”,
“abundance” and “often” which can be
confusing
High in Monounsaturated fats -
olives, olive oil, avocados, nuts and
seeds,
Moderate wine intake vs use of certain
medications, high triglycerides or
pancreatitis
High in cancer-fighting antioxidants Physical activity and calorie totals not
addressed specifically
Promotes regular physical activity
Less processed foods = less
sodium
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DASH Diet (Dietary Approaches to Stop Hypertension)
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Pros Cons
includes fruits, vegetables, whole
grains, beans, lean meats and plant
based fats, low-fat free dairy
Not specifically for weight loss
Free and available access – no
expensive or hard-to-find foods
No pre-package foods
Provided specific calorie levels for
weight loss and maintenance
Can provide up to 55% of calories from
carbohydrates – too high?
Proven health benefits in heart
health
Limited research on it’s effects on
diabetes
Promotes regular physical activity
Less processed foods = less sodium
Is designed to be an “eating
program for life” by including
cooking and shopping
Low Carbohydrate
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Pros Cons
Weight loss in a short time % carbohydrate recommendation varies
from <26%-45% of total calories
Helps with satiety due to protein and
fat intake
Calorie restrictions vary – “all you want”
to “very restricted”
Improves blood glucose control Decreased fiber intake – can promote
constipation
Has positive effects on HDL
cholesterol and triglycerides
May require supplements to replace what
is missing
Decrease in adipose tissue Sustainability?
Decrease food intake and body
weight
Little to no effect on LDL cholesterol and
total cholesterol
Have to pay attention to food
choices
Low Glycemic Index Diet
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Pros Cons
Quick and easy references The rating is only for individual foods. As
the food ripens or if it is paired with
protein or fat it can affect the GI ranking.
Good way to ID how individual foods
effect blood glucose
Misleading if you consider the GI rank to
mean that a food is healthy if it is low.
Can decrease blood glucose, insulin
response and maybe inflammation
GI number is only really valid if the food
is eaten alone.
Helps you feel full longer = more
weight loss
High Protein Diets
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Pros Cons
Targets metabolic targets of satiety
– may be more important than low
carbohydrate
Initial weight loss is temporary due to
water loss
Immediate weight loss Can effect mood, energy
Improves cholesterol Often the fat choices are mostly
saturated fats which may lead to higher
LDL levels
Improved satiety Sustainability?
Improved blood glucose Inflexible rules
Easy to find foods to eat
Have to pay attention to food
choices
Carbohydrate Controlled Diet
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Pros Cons
Consistent intake over the day Portions matter
Provides plenty of fiber, vitamins
and minerals
For some, can be more confusing
Provides structure to the day. Takes practice and discipline
Helps with insulin administration
No “I can’t have” rules
Stabilizes blood glucose
Addresses heart health
What is the right answer?
▪ What is the goal of the patient?
▪ Any eating pattern is most effective when starting where the patient’s
eating patterns are
▪ Eating pattern that is sustainable
▪ Family support is critical
▪ Meets the nutrition status and comorbidity issues, such as renal disease
▪ Has physical and emotional support along the way
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Consensus recommendation*
▪ All people with type 2 diabetes should be offered access to
ongoing DSMES programs
▪ An individualized program of Medical Nutrition Therapy (MNT)
should be offered to all patients.
▪ All overweight/obese patients should be advised of the health
benefits of weight loss and encouraged to engage in a program of
intensive lifestyle management, which may include food
substitution.
Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and
the European Association for the Study of Diabetes (EASD)
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Thank you!
References:
o American Diabetes Association (2018) 4. Lifestyle management:
standards of medical care in diabetes—2018. Diabetes Care
41:S38–S50. https://doi.org/10.2337/dc18-S004
o Beck J, Greenwood DA, Blanton L et al (2017) 2017 national
standards for diabetes self-management education and support.
Diabetes Educ 43:449–464
o Shai I, Schwarzfuchs D, Henkin Y et al (2008) Weight loss with a
low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med
359:229–241. https://doi.org/10.1056/NEJMoa0708681
o Esposito K, Maiorino MI, Ciotola M et al (2009) Effects of a
Mediterranean-style diet on the need for antihyperglycemic drug
therapy in patients with newly diagnosed type 2 diabetes: a
randomized trial. Ann Intern Med 151:306–314
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References:
o Esposito K, Maiorino MI, Petrizzo M et al (2014) The effects of a
Mediterranean diet on the need for diabetes drugs and remission of
newly diagnosed type 2 diabetes: follow-up of a randomized trial.
Diabetes Care 37:1824–1830. https://doi.org/10.2337/dc13-2899
o American Association of Diabetes Educators (2018) Addressing Obesity
in Diabetes – an AADE practice paper, August 2018
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