Medical Nutrition Therapy in Diabetes

On the basis of the medical literature and sound clinical practice, medical nutrition therapy with effective weight reduction improves glycemic control, metabolic disturbances and vascular complications in T2D.

But current nutritional recommendations for patients with T2D in general do not attach great importance to weight loss. The goals of medical nutrition therapy aimed at by the ADA focus on attaining and maintaining optimal metabolic outcomes, on preventing and treating the chronic complications of diabetes, on improving health through healthy food choices and physical activity, and on addressing individual nutritional needs [12]. There is evidence that all these goals are easily reached or somewhat better reached with a reduction of body weight. However, it seems to be a common belief among physicians that nutritional therapy in T2D is not efficient. To optimize glycemic control physicians often start with drug or insulin therapy before the effects of diet treatment are assessable [13].

In view of recent consistent and strong evidence that weight reduction improves insulin sensitivity and glycemic control in T2D, the Joslin Diabetes Center and Joslin Clinic recommended clinical guidelines for overweight and obese adults with T2D, prediabetes or high risk of developing T2D that consider weight reduction as one of the prime objectives of any nutrition recommendations for patients with diabetes. Among others the guidelines advise that weight reduction should be individualized and continued until BMI reaches <25 kg/m2 or an until a BMI goal which has been agreed upon is reached, that individuals should learn and practice portion control as an effective way of weight control, and that meal replacements may be used [14].

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