Nutritional Therapy in Diabetes
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2016 ADA Guideline Recommendations |
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Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
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Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]
2016 ADA Standards of Medical Care in Diabetes Guidelines
EFFECTIVENSS OF NUTRITION THERAPY
| "1. An individualized MNT program, preferably provided by a registered dietitian, is recommended for all people with type 1 or type 2 diabetes. (Level of Evidence: A)" |
| "2. For people with type 1 diabetes or those with type 2 diabetes who are prescribed a flexible insulin therapy program, education on how to use carbohydrate counting or estimation to determine mealtime insulin dosing can improve glycemic control (Level of Evidence: A)" |
| "3.For individuals whose daily insulin dosing is fixed, having a consistent pattern of carbohydrate intake with respect to time and amount can result in improved glycemic control and a reduced risk of hypoglycemia.(Level of Evidence: B)" |
| "4.A simple and effective approach to glycemia and weight management emphasizing healthy food choices and portion control may be more helpful for those with type 2 diabetes who are not taking insulin, who have limited health literacy or numeracy, and who are elderly and prone to hypoglycemia (Level of Evidence: C)" |
| "5. Because diabetes nutrition therapy can result in cost savings(Level of Evidence: B) and improved outcomes (e.g., A1C reduction) (Level of Evidence: A)' MNT should be adequately reimbursed by insurance and other payers. (Level of Evidence: E)" |
ENERGY BALANCE
| "1.Modest weight loss achievable by the combination of lifestyle modification and A the reduction of energy intake benefits overweight or obese adults with type 2
diabetes and also those at risk for diabetes. Interventional programs to facilitate this process are recommended (Level of Evidence: A)" |
IMMUNIZATION
| "1. Provide routine vaccinations for children and adults with diabetes as for the general population ac- cording to age-related recommendations (Level of Evidence: C)" |
| "2.Administer hepatitis B vaccine to unvaccinated adults with diabetes who are aged 19–59 years. (Level of Evidence: C)" |
| "3. Consider administering hepatitis B vaccine to unvaccinated adults with diabetes who are aged >60 years. (Level of Evidence: C)" |
PSYCHOSOCIAL ISSUES
| "1. The patient’s psychological and social situation should be ad- dressed in the medical manage- ment of diabetes. (Level of Evidence: B)" |
| "2. Psychosocial screening and follow- up may include, but are not lim- ited to, attitudes about the illness, expectations for medical man- agement and outcomes, affect/ mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. (Level of Evidence: E)" |
| "3.Routinely screen for psychoso- cial problems such as depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment. (Level of Evidence: B)" |
| "4. Older adults (aged $65 years) with diabetes should be consid- ered for evaluation of cognitive function and depression screening and treatment. (Level of Evidence: B)" |
| "5. Patients with comorbid diabetes and depression should receive a stepwise collaborative care ap- proach for the management of depression (Level of Evidence: A)" |
COMPREHENSIVE MEDICAL EVALUATION
A complete medical evaluation should be performed at the initial visit to| "1. Confirm the diagnosis and classify
diabetes (Level of Evidence: B)" |
| "2. Detect diabetes complications and
potential comorbid conditions. (Level of Evidence: E)" |
| "3.Review previous treatment and risk factor control in patients
with established diabetes (Level of Evidence: E)" |
| "4. Begin patient engagement in the formulation of a care manage-
ment plan. (Level of Evidence: B)" |
| "5. Develop a plan for continuing care (Level of Evidence: B)" |