Nutrition therapy and counselling are an integral part of the treatment and self-management of diabetes. The goals of nutrition therapy are to maintain and improve quality of life and nutritional and physiological health; and to prevent and treat acute and long-term complications of diabetes.
It is well documented that nutrition therapy can improve glycemic control by reducing A1C by 1.0% to 2.0%, and, when used with other components of diabetes care, can further improve clinical and metabolic outcomes, resulting in reduced hospitalization rates. Furthermore, frequent follow-up (i.e. every 3 months) with a registered dietitian (RD) has been associated with better dietary adherence in type 2 diabetes.
In general, people with diabetes should follow the healthy diet recommended for the general population in Eating Well with Canada's Food Guide. This involves consuming a variety of foods from the 4 food groups (vegetables and fruits; grain products; milk and alternatives; meat and alternatives), with an emphasis on foods that are low in energy density and high in volume to optimize satiety and discourage overconsumption. This diet may help a person attain and maintain a healthy body weight while ensuring an adequate intake of carbohydrate, fibre, fat and essential fatty acids, protein, vitamins and minerals.
Overall, nutrition counseling should be individualized and reinforced, and incorporate self-management education. As evidence is limited for the rigid adherence to any single dietary prescription, nutrition therapy and meal planning should be individualized to accommodate the individual's age, type and duration of diabetes, concurrent medical therapies, treatment goals, values, preferences, needs, culture, lifestyle, economic status, activity level, readiness to change and abilities.
Summary of the 2013 CDA Recommendations are as follows:
People with diabetes should receive nutrition counselling by a registered dietitian to lower A1C levels and to reduce hospitalization rates.
Nutrition education is effective when delivered in either a small group or a one-on-one setting. Group education should incorporate adult education principles, such as hands-on activities, problem solving, role playing and group discussions.
Individuals with diabetes should be encouraged to follow Eating Well with Canada's Food Guide in order to meet their nutritional needs.
In overweight or obese people with diabetes, a nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight.
In adults with diabetes, the macronutrient distribution as a percentage of total energy can range from 45% to 60% carbohydrate, 15% to 20% protein and 20% to 35% fat to allow for individualization of nutrition therapy based on preferences and treatment goals.
Adults with diabetes should consume no more than 7% of total daily energy from saturated fats and should limit intake of trans fatty acids to a minimum.
Added sucrose or added fructose can be substituted for other carbohydrates as part of mixed meals up to a maximum of 10% of total daily energy intake, provided adequate control of BG and lipids is maintained.
People with type 2 diabetes should maintain regularity in timing and spacing of meals to optimize glycemic control.
An intensive lifestyle intervention program combining dietary modification and increased physical activity may be used to achieve weight loss and improvements in glycemic control and cardiovascular risk factors.
People with type 1 diabetes should be taught how to match insulin to carbohydrate quantity and quality or should maintain consistency in carbohydrate quantity and quality.
People using insulin or insulin secretagogues should be informed of the risk of delayed hypoglycemia resulting from alcohol consumed with or after the previous evening's meal and should be advised on preventive actions such as carbohydrate intake and/or insulin dose adjustments and increased BG monitoring.
