LORENA DRAGO MS RD CDN CDE Lifestyle Solutions for People with Diabetes

ACHIEVE AND MAINTAIN : BLOOD GLUCOSE LEVELS IN THE NORMAL RANGE OR AS CLOSE TO NORMAL AS IS SAFELY POSSIBLE A LIPID AND LIPOPROTEIN PROFILE THAT REDUCES THE RISK FOR VASCULAR DISEASE BLOOD PRESSURE LEVELS IN THE NORMAL RANGE OR AS CLOSE TO NORMAL AS IS SAFELY POSSIBLE Medical Nutrition Therapy (MNT) in Diabetes Management

MNT HAS REPORTED DECREASES IN HBA1C OF: ~1% in type 1 1-2% in type 2 MNT REDUCES LDL-C 15-25mg/dl MNT EFFECTIVE IN REDUCING HTN IMPROVEMENTS APPARENT IN 3-6 MONTHS Effectiveness of MNT

Table 1 DSEIa sessions, topics and retention items. The Look AHEAD Research Group Clin Trials 2011;8: Copyright © by The Society for Clinical Trials

Unexpected Result

LIFESTYLE INTERVENTION (LI) PRODUCED Moderate weight loss 6.2% vs. 0.9 among diabetes support and education Intervention group did not reduce the occurrence of heart attacks or stroke below what was seen in the study’s diabetes education and support group LI REDUCED DIABETES MEDICATION, BLOOD PRESSURE, HDL-C, TG, INCREASED FITNESS AND FUNCTIONAL MOBILITY AND GREATER IMPROVEMENTS IN Q.O.L AND IN SLEEP APNEA LOOK AHEAD RESULTS

DIABETES CARE, VOLUME 27, NUMBER 2, FEBRUARY % of respondents cut back on diabetes medication 11% reported cut back 7% reported cut back once per month 28% reported forgoing food/essentials to pay medication costs 14% increased their credit card debt 10% borrowed money NY TIMES November 2010

FOR THE MANAGEMENT OF ADULTS WITH DIABETES DIABETES CARE PUBLISHED OCTOBER 9,2013 Nutrition Therapy Recommendations

A1C <7% BLOOD PRESSURE <140/80 MMHG LDL CHOLESTEROL <100MG/DL TRIGLYCERIDES <150MG/DL HDL >40 MG/DL FOR MEN HDL>50MG/DL FOR WOMEN Goals of Nutrition Therapy

Culture Health Literacy Food Access Barriers Pleasure of Eating Positive Food Choices Meal Planning Tools vs Macro or Micro Nutrients/Single Foods

Energy Balance Overweight/Obese type 2 Adults Reduce energy intake to promote modest weight loss Maintain healthy eating patterns Provide nutrition counseling, PA, behavior change, ongoing support Evidence rating A

Optimal Mix of Macronutrients MEAL FatCarbsProtein No ideal percentage of macronutrient distribution (B) Macronutrient distribution individualized (E)

Carbohydrate Blood Glucose Levels Carbs CHO Intake Availabl e Insulin Amount of CHO & available insulin most important factor in glycemic response (A)

Carbohydrates Carbohydrate amount is inconclusive (C) Monitoring CHO via (B)  Carbohydrate counting  Experience-based estimation Recommended Carbohydrate sources (B):  Fruits/vegetables  Legumes  Whole grains  Dairy

Glycemic Index and Glycemic Load Substitute high GL with low GL Improve glycemic control Evidence rating C

Dietary Fiber and Whole Grains Dietary Fiber Same recommendations for general public Whole Grains Same recommendations for general public Evidence rating C

Fructose Fructose consumed as “free fructose” (fruits) may result in better glycemic control compared with isocaloric intake of sucrose or starch (B) Free fructose not likely to have detrimental effects on TG if <12% of energy (C)  1500 calories X 15% = 225 calories  225 calories/4kcal/g CHO = 56 g CHO  56g CHO = ~4 servings fruit per day Limit or avoid SSB to reduce risk for weight gain and worsening of cardiometabolic risk profile (B)

Substitution of Sucrose for Starch Substituting sucrose-containing foods for isocaloric amounts of other CHO may have similar blood glucose effects (A) Minimize consumption of sucrose-containing foods to avoid displacing nutrient-dense foods (A)

Non-Nutritive Sweeteners Potential to reduce overall  Calories  Carbohydrate Caveat: Overcompensating with additional calories Evidence rating B

Protein No CKD Amount Inconclusive (C) With CKD No less than RDA (A)

Total Fat Total Amount Inconclusive: Individualize Goals (C) Quality vs Quantity (B)

MUFAs and PUFAs Mediterranean-style may benefit glycemic control & CVD risk factors (B) Effective alternative to lower-fat, high-CHO eating patterns (B)

Omega-3 Fatty Acids No Omega-3 supplements for CVD events (A) Increase in foods with O-3 2x/week (B)

People with Diabetes People WITHOUT Diabetes Saturated Fat, Dietary Cholesterol, Trans-Fats RECOMMENDATIONS: SAME (C)

Diabetes w/Dyslipidemia Results Plant Stanols and Sterols Modestly reduce LDL-C Consuming 1.6-3g/day Evidence rating C

Sodium 2,300mg/dl

Alcohol Men -2 Women -1 (E) Delayed Hypoglycemia (C)

LORENA DRAGO THANK YOU Book: Beyond Rice and Beans Nutriportion Measuring Cups