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Canadian Diabetes Association Clinical Practice Guidelines Nutrition Therapy

Canadian Diabetes Association Clinical Practice Guidelines Nutrition Therapy. Chapter 11 Paula D. Dworatzek , Kathryn Arcudi , Réjeanne Gougeon , Nadira Husein , John L. Sievenpiper , Sandi Williams. Nutrition Checklist. 2013.

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Canadian Diabetes Association Clinical Practice Guidelines Nutrition Therapy

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  1. Canadian Diabetes Association Clinical Practice GuidelinesNutrition Therapy Chapter 11 Paula D. Dworatzek, Kathryn Arcudi, RéjeanneGougeon, NadiraHusein, John L. Sievenpiper, Sandi Williams

  2. Nutrition Checklist 2013 • REFER for nutrition counseling by a registered dietitian • FOLLOW Eating Well with Canada’s Food Guide • INDIVIDUALIZE dietary advice based on preferences and treatment goals • CHOOSE low glycemic index carbohydrate food sources

  3. Nutrition Checklist (continued) 2013 • KNOW alternative dietary patterns for type 2 diabetes • ENCOURAGE matching of insulin to carbohydrate in type 1 diabetes • ENCOURAGE nutritionally balanced, calorie-reduced diet in overweight or obese patients

  4. Encourage patients to follow Eating Well with Canada’s Food Guide in order to meet their nutritional needs http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

  5. Macronutrient Distribution (% Total Energy) BW = body weight

  6. Choosing Foods Using % Daily Value Daily Values > 15% = a lot Daily Value < 5% = a little http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/fact-fiche-eng.php

  7. For Patients with BMI ≥25 kg/m2… Weight loss of 5-10% of initial body weight Improved insulin sensitivity, glycemic control, blood pressure control, lipid levels Nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight

  8. Choose low glycemic index carbohydrates www.guidelines.diabetes.ca

  9. Figure 1 – Nutritional management of hyperglycemia in type 2 diabetes 2013 Initiate intensive lifestyle intervention or energy restriction + increased physical activity to achieve/maintain a healthy body weight If not at target Continue lifestyle intervention and add pharmacotherapy Timely adjustments to lifestyle intervention and/or pharmacotherapy should be made to attain target A1C within 2 to 3 months for lifestyle intervention alone or 3-6 months for any combination with pharmacotherapy

  10. Properties of Macronutrients 2013

  11. Properties of Dietary Patterns 2013

  12. Recommendations 1 and 2 People with diabetes should receive nutrition counseling by a registered dietitian to lower A1C levels [Grade B, Level 2, for type 2 diabetes; Grade D, Consensus, for type 1 diabetes], and reduce hospitalization rates [Grade C, Level 2] Nutrition education is effective when delivered in either a small group or one-on-one setting [Grade B, Level 2]. Group education should incorporate adult education principles, such as hands-on activities, problem solving, role-playing, and group discussions [Grade B, Level 2]

  13. Recommendations 3 and 4 2013 Individuals with diabetes should be encouraged to follow Eating Well with Canada’s Food Guide in order to meet their nutritional needs [Grade D, Consensus] 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 [Grade A, Level 1A]

  14. Recommendations 5 and 6 2013 2013 In adults with diabetes, the macronutrient distribution as a percentage of total energy can range from 45-60% carbohydrate, 15-20% protein, and 20-35% fat to allow for individualization of nutrition therapy based on preference and treatment goals [Grade D, consensus] Adults with diabetes should consume no more than 7% of total daily energy from saturated fats[Grade D, Consensus] and should limit intake of trans fatty acids to a minimum [Grade D, Consensus]

  15. Recommendations 7 and 8 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 [Grade C, Level 3] People with type 2 diabetes should maintain regularity in timing and spacing of meals to optimize glycemic control [Grade D, Level 4]

  16. Recommendation 9 Dietary advice may emphasize choosing carbohydrate food sources with a low glycemic index to help optimize glycemic control [type 1 diabetes: Grade B, Level 2; type 2 diabetes: Grade B, Level 2]

  17. Recommendation 10 2013 • Alternative dietary patterns may be used in people with T2DM to improve glycemic control, (including): • Mediterranean-style dietary pattern [Grade B, Level 2] • Vegan or vegetarian dietary pattern [Grade B, Level 2] • Incorporation of dietary pulses (e.g., beans, peas, check peas, lentils) [Grade B, Level 2] • Dietary Approaches to stop Hypertension (DASH) dietary pattern [Grade B, Level 2]

  18. Recommendations 11 and 12 11. 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 [Grade A, Level 1A] 12. People with type 1 diabetes should be taught how to match insulin to carbohydratequantity and quality [Grade C, Level 2];orshould maintain consistency in carbohydrate quantity and quality [Grade D, Level 4]

  19. Recommendations 13 13. People using insulin or insulin secretagoguesshould be informed of the risk of delayed hypoglycemia resulting from alcohol consumed with or after the previous evening’s meal [Grade C, Level 3] and should be advised on preventive actions such as carbohydrate intake and/or insulin dose adjustments, and increased BG monitoring [Grade D, Consensus].

  20. CDA Clinical Practice Guidelines http://guidelines.diabetes.ca – for professionals 1-800-BANTING (226-8464) http://diabetes.ca – for patients

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