The 2006 American Diabetes Association Nutrition Recommendations and Interventions for the Prevention and Treatment of Diabetes

Abstract

The 2006 American Diabetes Association (ADA) nutrition recommendations reaffirm the importance of medical nutrition therapy (MNT) in the prevention of diabetes, treatment of existing diabetes, and prevention and treatment of the complications of diabetes in which MNT plays a role. The differences between the 2002 technical review1 and the 2006 position statement2 reflect research published after 2000. The recommendations continue to be graded according to the ADA evidence grading system. MNT, as illustrated in Table 1, plays a vital role across the continuum of diabetes, and interventions change as the disease progresses. Primary prevention first seeks to reduce the prevalence of obesity and thus reduce the risk of developing pre-diabetes and diabetes. For individuals with pre-diabetes, MNT focuses on the prevention or delay of diabetes by moderate weight loss and increased physical activity. However, when overt diabetes develops, MNT interventions focus on normalization of metabolic parameters to prevent or control the complications of diabetes. View this table: Table 1. Nutrition and MNT MNT for people at risk for and with diabetes should be individualized, and clinical trials and outcome studies suggest that such therapy is best provided by a registered dietitian familiar with diabetes. Monitoring of metabolic parameters, including glucose, hemoglobin A1c (A1C), lipids, blood pressure, body weight, and renal function, is essential to assess the need for changes in therapy to ensure successful outcomes. Taking into account an individual's personal needs, willingness, and ability to change remains crucial. Clinical trials and outcome studies of MNT have reported decreases in A1C of ∼ 1% in type 1 diabetes and 1–2% in type 2 diabetes, depending on the duration of diabetes.3 After initiation of MNT, improvements were apparent in 6 weeks to 3 months. Meta-analysis of studies in nondiabetic, free-living subjects and expert committees report that MNT reduces LDL cholesterol by …