//fpnotebook.com/
Nutrition in Diabetes Mellitus Type 2
Aka: Nutrition in Diabetes Mellitus Type 2, Nutrition in Diabetes Mellitus Type II, Type 2 Diabetic Diet, Intensive Lifestyle Change In Type II Diabetes Mellitus
- See Also
- Nutrition in Diabetes Mellitus
- Carbohydrate Count
- Nutrition in Diabetes Mellitus Type I
- Type II Diabetes Mellitus
- Goals
- First priority: Blood Glucose control
- Second priority: Weight loss
- Do not overemphasize weight loss
- Weight loss goal: 10-20 pounds or 10% weight loss
- Better Blood Sugar control results in weight gain
- DCC Trial found Blood Sugar control more important
- Reference
- Watts (1990) Arch Intern Med 150(4):803-6 [PubMed]
- Efficacy
- Intensive lifestyle intervention (Look Ahead Study)
- Results in up to 5% weight loss and improved glycemic control (or in up to 20%, diabetes remission)
- Best outcomes are for early intervention (<2 years of type 2 diabetes)
- Gregg (2012) JAMA 308(23): 2489-96 [PubMed]
- Management: General Approach
- Moderately restrict calories
- Improves Blood Sugar control (and secondarily decreases weight)
- Eat less often and in smaller portions and substitute more healthy food choices
- Weigh or measure food quantity and track accurately
- Diet and fitness tracking applications are widely available and easy to use
- Limit triggers for eating (e.g. less time around restaurants) and other less healthy behaviors
- Establish strategies for specific situations (social, parties, vacations)
- Hypocaloric diet more important than weight loss
- Wing (1987) Arch Intern Med 147:1749-53 [PubMed]
- Adjust Meal Schedule
- Break up Caloric Intake
- Breakfast: 20%
- Lunch: 40%
- Dinner: 40%
- Intersperse small snacks between meals
- Crackers or juice in afternoon and at bedtime
- Jenkins (1992) Am J Clin Nutr 55(2): 461-7 [PubMed]
- Modify fat intake
- Decrease overall fat intake
- Avoid saturated fats
- Switch to monounsaturated or polyunsaturated fats
- Eating nuts and peanut butter reduces NIDDM risk
- Jiang (2002) JAMA 288:2554-60 [PubMed]
- Increase Physical Activity
- See Exercise in Diabetes Mellitus
- Track Heart Rate and exertional level
- Periodically increase activity throughout the day (e.g. bout of brisk walking)
- Walk stairs instead of taking elevators
- Goal: 175 minutes weekly Exercise (look-ahead program)
- Management: Look Ahead Study Protocol (intensive management)
- Background
- Adapted for Diabetes Mellitus II from the CDC Intensive Diabetes Prevention Program (DPP)
- Goals
- Weight loss 10% and Exercise 175 minutes per week
- Protocols
- See general measures above
- Look Ahead program recommended commercial meal replacements for breakfast and lunch for the first 6 months
- Resources: Look Ahead materials for counselors and patients
- https://www.lookaheadtrial.org/publicResources/interventionMaterial.cfm?docCollectionGUID=5f2e0038-831a-4401-9d11-95a38e7c2c49
- References
- Koenigsberg (2017) Am Fam Physician 96(6):362-70 [PubMed]