Medical Nutrition Therapy Options for Adults Living with Diabetes - Jane Eyre Schuster, RD, LD, CDE Legacy Health Diabetes and Nutrition Services ...
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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.
October 26, 2018 LEGACY HEALTH 3Diabetes 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
10/26/2018 LEGACY HEALTH 4Medical 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
10/26/2018 LEGACY HEALTH 5Diabetes 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
10/26/2018 LEGACY HEALTH 6Eating 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
▪ ???
10/26/2018 LEGACY HEALTH 7Mediterranean Diet
Pros Cons
includes fruits, vegetables, whole Does not state exact servings
grains, beans, moderate intake of amounts/day, rather the macronutrient
wine and lean meats and low intake distribution
of processed foods
Promotes heart health Uses terms like: “low to moderate intake”,
“abundance” and “often” which can be
confusing
High in Monounsaturated fats - Moderate wine intake vs use of certain
olives, olive oil, avocados, nuts and medications, high triglycerides or
seeds, pancreatitis
High in cancer-fighting antioxidants Physical activity and calorie totals not
addressed specifically
Promotes regular physical activity
Less processed foods = less
sodium
10/26/2018 LEGACY HEALTH 8DASH Diet (Dietary Approaches to Stop Hypertension)
Pros Cons
includes fruits, vegetables, whole Not specifically for weight loss
grains, beans, lean meats and plant
based fats, low-fat free dairy
Free and available access – no No pre-package foods
expensive or hard-to-find foods
Provided specific calorie levels for Can provide up to 55% of calories from
weight loss and maintenance carbohydrates – too high?
Proven health benefits in heart Limited research on it’s effects on
health diabetes
Promotes regular physical activity
Less processed foods = less sodium
Is designed to be an “eating
program for life” by including
cooking and shopping
10/26/2018 LEGACY HEALTH 9Low Carbohydrate
Pros Cons
Weight loss in a short time % carbohydrate recommendation varies
fromLow Glycemic Index Diet
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 Misleading if you consider the GI rank to
effect blood glucose mean that a food is healthy if it is low.
Can decrease blood glucose, insulin GI number is only really valid if the food
response and maybe inflammation is eaten alone.
Helps you feel full longer = more
weight loss
10/26/2018 LEGACY HEALTH 11High Protein Diets
Pros Cons
Targets metabolic targets of satiety Initial weight loss is temporary due to
– may be more important than low water loss
carbohydrate
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
10/26/2018 LEGACY HEALTH 12Carbohydrate Controlled Diet
Pros Cons
Consistent intake over the day Portions matter
Provides plenty of fiber, vitamins For some, can be more confusing
and minerals
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
10/26/2018 LEGACY HEALTH 13What 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
10/26/2018 LEGACY HEALTH 14Consensus 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)
10/26/2018 LEGACY HEALTH 15Thank 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 10/26/2018 LEGACY HEALTH 17
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
10/26/2018 LEGACY HEALTH 18You can also read
