Transcript Lifestyle Solutions for People with Diabetes

Lifestyle Solutions for
People with Diabetes
LORENA DRAGO MS RD CDN CDE
Medical Nutrition Therapy (MNT)
in Diabetes Management
ACHIEVE AND MAINTAIN :
•B L O O D G L U C O S E L E V E L S I N T H E N O R M A L R A N G E O R
AS CLOSE TO NORMAL AS IS SAFELY POSSIBLE
•A L I P I D A N D L I P O P R O T E I N P R O F I L E T H A T R E D U C E S
THE RISK FOR VASCULAR DISEASE
•B L O O D P R E S S U R E L E V E L S I N T H E N O R M A L R A N G E O R
AS CLOSE TO NORMAL AS IS SAFELY POSSIBLE
Effectiveness of MNT
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
Table 1 DSEIa sessions, topics and retention items.
The Look AHEAD Research Group Clin Trials 2011;8:320329
Copyright © by The Society for Clinical Trials
Unexpected Result
LOOK AHEAD RESULTS
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
NY TIMES November 2010
19% 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
DIABETES CARE, VOLUME 27, NUMBER 2, FEBRUARY 2004
Nutrition Therapy
Recommendations
FOR THE MANAGEMENT OF ADULTS WITH
DIABETES
DIABETES CARE PUBLISHED OCTOBER 9,2013
Goals of Nutrition Therapy
•A 1 C < 7 %
•B L O O D P R E S S U R E < 1 4 0 / 8 0 M M H G
•L D L C H O L E S T E R O L < 1 0 0 M G / D L
•T R I G L Y C E R I D E S < 1 5 0 M G / D L
•H D L > 4 0 M G / D L F O R M E N
•H D L > 5 0 M G / D L F O R W O M E N
Goals of Nutrition Therapy
Culture
Health Literacy
Food Access
Barriers
Meal Planning
Tools
vs
Macro or Micro
Nutrients/Single
Foods
Pleasure of Eating
Positive Food
Choices
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
Protein
Carbs
Fat
MEAL
No ideal percentage of
macronutrient distribution (B)
Macronutrient distribution
individualized (E)
Carbohydrate
Carbs
Amount of CHO & available
insulin most important factor
in glycemic response (A)
CHO
Intake
Available
Insulin
Blood Glucose Levels
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
With CKD
No less than
RDA (A)
No CKD
Amount
Inconclusive
(C)
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
Increase in foods
with O-3
2x/week (B)
No Omega-3
supplements for
CVD events (A)
Saturated Fat, Dietary Cholesterol, Trans-Fats
People with Diabetes
People WITHOUT
Diabetes
Plant Stanols and Sterols
Diabetes w/Dyslipidemia
Results
Modestly
reduce LDL-C
Consuming
1.6-3g/day
Evidence rating C
Sodium
2,300mg/dl
Alcohol
Delayed
Hypoglycemia (C)
Men -2
Women -1 (E)
THANK YOU
LORENA DRAGO
[email protected]
WWW.LORENADRAGO.COM
Book:
Beyond Rice
and Beans
Nutriportion
Measuring
Cups