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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn general, a variety of eating patterns are acceptable for the management of diabetes, as long as follow-up encounters and ongoing support are implemented. This article discusses the need for medical nutrition counseling as a component of an overall management strategy to achieve treatment goals in adults with type 1 diabetes mellitus or type 2 diabetes mellitus.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology Diabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe need for medical nutrition counseling as a component of an overall management strategy to achieve treatment goals in adults with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) was addressed by Marion J. Franz, MS, RDN, CDE, Nutrition Concepts by Franz, Inc., Minneapolis, Minnesota, USA. In general, a variety of eating patterns are acceptable for the management of diabetes, as long as follow-up encounters and ongoing support are implemented.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMedical nutrition therapy is defined by the Institute of Medicine as evidence-based application of the nutrition care process provided by registered dietitian nutritionists. Both medical nutrition therapy and nutrition therapy should involve a nutritional assessment, diagnosis, intervention, monitoring, and evaluation.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe role of the glycemic index (GI) and macronutrient composition of diets, as well as other aspects of nutrition therapy in diabetes, remain unclear, and professional organizations using similar review processes have reached different conclusions regarding their utility. As a result, current recommendations can be conflicting. For example, the level of evidence to support the efficacy of low-GI diets to improve glycemic control has received different recommendations by the Diabetes UK Nutrition Working Group (Grade A) [Dyson PA et al. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2011] and American Diabetes Association (ADA; Grade C) [Evert AB et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013]. In contrast, the Academy of Nutrition and Dietetics rates the level of evidence as fair [Academy of Nutrition and Dietetics \u003Cem\u003EEvidence Analysis Library\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA systematic Cochrane Review of 11 randomized controlled studies (n = 402) conducted in adults with diabetes not optimally controlled found a statistically and clinically significant decrease in HbA\u003Csub\u003E1c\u003C\/sub\u003E with a weighted mean difference of \u2212.5% in both the parallel group of trials (p = .02) and crossover group of trials (p = .03) with a low-GI diet [Thomas D, Elliott EJ. \u003Cem\u003ECochrane Database Syst Rev\u003C\/em\u003E 2009]. The ADA concluded from its systematic review that differences in glycemic control and cardiovascular (CV) risk factors were small between low-GI and high-GI or other diets and that any improvement in glycemia from a low-GI diet may be confounded by higher fiber intake [Wheeler ML et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2012]. The Academy of Nutrition and Dietetics concluded there were mixed effects of GI on HbA\u003Csub\u003E1c\u003C\/sub\u003E [Academy of Nutrition and Dietetics \u003Cem\u003EEvidence Analysis Library\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe utility of the GI concept therefore remains unknown. Franz explained that the GI is the relative area under the glucose curve of 50 g of digestible carbohydrate from a test food compared with 50 g of glucose. It does not measure how rapidly blood glucose levels increase after carbohydrate intake. The glucose response curve does not differ with the consumption of different foods. In an analysis of a database of \u0026gt; 1126 foods and glucose responses in individuals without diabetes, glucose peaks occurred at approximately 30 min regardless of the food\u0027s GI. Furthermore, low-GI foods did not produce an extended, sustained glucose response [Brand-Miller JC et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EMedical nutrition therapy, however, is effective in reducing HbA1c levels and improving CV risk factors in patients with diabetes [Evert AB et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013; Andrews RC et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011; Coppell KJ et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2010; Knowler WC et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009; Appel LJ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2003]. The reduction in HbA\u003Csub\u003E1c\u003C\/sub\u003E levels is approximately 1% to 2% depending on the type of diabetes and the duration and level of glycemic control, a level of improvement similar to that obtained with glucose-lowering medication.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere is no ideal percentage of macronutrients (carbohydrate, protein, and fat) for nutrition or weight loss in diabetes, said Franz. Reducing total energy intake while maintaining a healthful eating pattern should take precedence over the macronutrient composition when promoting weight loss for persons with T2DM. A variety of nutrition interventions (ie, reduced energy and fat intake, carbohydrate counting, and simplified meal plans) along with multiple individual or group sessions and follow-up encounters have been shown to be effective in improving glycemic control and CV risk factors.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EMost people with diabetes report a moderate GI and carbohydrate intake. Franz recommended eating a moderate amount of carbohydrates from vegetables, fruits, whole grains, legumes, and low-fat dairy products.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EModest weight loss, defined as about 5% of initial weight, and increased physical activity improve glycemic control, blood pressure, and the lipid profile while decreasing levels of circulating inflammatory markers, especially when used early in the disease process [Klein S et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. A reduction in body weight can also prevent or delay the development of T2DM [Knowler WC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002]. Weight loss may be difficult to maintain because weight is tightly regulated by neural, hormonal, and metabolic factors [Camps SG et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2013; Sumithran P et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. Ongoing support is crucial regardless of the type of intervention to promote weight loss, because weight gain occurs when treatment is discontinued.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIf weight loss does not lead to improved glycemic control, the intervention may not have been intense enough or may have been implemented too late in the disease (when insulin deficiency has occurred).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EFor patients with T1DM, adjusting premeal insulin doses to planned carbohydrate intake is beneficial. The amount of carbohydrate in the meal does not affect acute glycemic control if premeal insulin is adjusted appropriately, said Jackie L. Boucher, MS, RDN, CDE, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA. Variations in the meal GI or intake of fiber or calories do not influence premeal insulin.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EHigh amounts of fat in a meal may also affect the insulin bolus calculation; higher-fat meals require more insulin coverage than do lower-fat meals with the same carbohydrate content in patients with T1DM [Wolpert HA et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013]. Extra protein in the meal has also been found to add to premeal insulin requirements. For example, 50 g of protein added to a standard meal eaten by patients with T1DM increased the late postprandial glucose response and insulin requirements by 2 to 3 units. The ADA states that basal insulin covers fat and protein insulin needs, and the need to bolus for protein and fat is only necessary when excessive amounts are eaten.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EBoucher concluded that a shift away from single nutrients to focusing more on the overall dietary pattern has occurred, and that a variety of eating patterns are acceptable for the management of diabetes.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/26\/19\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the 2014 American Association of Diabetes Educators presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1623388545\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the 2014 American Association of Diabetes Educators presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/26\/19\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/26\/19\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/26\/19\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15032\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the 2014 American Association of Diabetes Educators presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/26\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}