Use of an Evidence-Based approach has become favorable in the development of recommendations for therapy in nursing practice. This approach reduces the frustrating and confusing theories and opinions from medical providers. The nutrition therapy is valid for both Type 1 and Type 2 diabetes. The goals of this therapy are to promote healthy eating and thus attain desirable glucose-lipid levels balance and recommended blood pressure level. The updated diabetes nutrition therapy is often linked with recommendations as per the American Diabetes Association (ADA) 2013. The findings show a relation between effectiveness, weight loss, eating patterns, and individualization in the implementations of the ADA recommendations (Franz, Boucher & Evert, 2014).
The nutrition therapy has been proved to be useful due to the ability to improve glycemic control. Assessment of glycemic control is done using hemoglobin A1C. (HbA1C). Nutrition therapy interventions have the effect of reducing the HbA1C levels by 0.23% to 2.6%. The factors affecting the amount of reduction of HbA1C levels include the type and duration of diabetes. For instance, the nutrition therapy for newly diagnosed Type 2 diabetes patients with HbA1C levels of 9% show consistency in the decrease by around 2%. Persons recently diagnosed with diabetes and having HbA1C levels 6.6%expereienced a reduction of 0.4%. This method is more efficient than adding a supplementary medication and at the same time, cost-effective. Nutrition therapy has been proved valuable due to the improved quality of life and reduced risk of hypoglycemia and cardiovascular complications (Franz, 2016). For a study conducted on over 18,000 people with diabetes, the challenge found is that the patients are often reluctant to visit nutritional clinics. Out of the 18000 people, only 9.1% had attended the dietary institutions over the course of 9 years. This indicates that the patients lack the knowledge on disease self-management, support, and nutrition therapy. Personal preferences such as tradition, culture, religion, health beliefs and the economic background affect the treatment using nutritional treatment (Franz, Boucher & Evert, 2014).
The health problems for persons at risk for type 2 diabetes are obesity and being overweight. Weight loss has been proved as an efficient way for glycemic control. The weight loss is usually achieved by improvements in HbA1C levels. According to the Nutrition and Dietetics report, the weight loss among people with type 2 diabetes is within the range of 1.9 kg and 8.4 kg. The individuals with poor lifestyle habits were assessed weekly for the first year and the next year; they were monitored monthly (Franz, Boucher & Evert, 2014). The strategy adopted for weight loss was prescription of liquid meal replacements and structured nutrition plans. The observation was that it is a complicated process for people with diabetes to lose weight. The review of 80 studies for 26455 samples indicated that the weight loss was at 8% of the baseline and that the average weight loss per participant was 7.5 kg. Use of nutrition therapy for weight loss only is effective for people with pre-diabetes. It is therefore critical to note that nutrition therapy goals are much broader than just loss of weight (Franz, Boucher & Evert, 2014).
The nutrition therapy is based on reduced energy intake with close monitoring of lifestyle changes. The source of energy for the majority of persons with diabetes in The US includes Carbohydrate - 45%; Fat - 35-40%; and protein - 16-18%. The macronutrients essentially require insulin for digestion and therefore, the macronutrient percentages and eating patterns must be closely monitored. The Glycemic Index (GI) load determine the type of carbohydrates based on the effect it has on glucose levels shortly after intake. People with diabetes should use high concentrations of fiber and whole grains. For males, increased fiber consumption of 14g/1000 kcal is recommended (Franz, Boucher & Evert, 2014). The breakdown based on gender is 25g and 30g daily for adult women and men respectively. The ADA suggestions also encourage the averting of sugar-sweetened beverages. To cope with this, several non-nutritive sweeteners have been approved for consumption. Research indicates that higher fat intake leads to more body insulin resistance. Therefore, reducing the amount of saturated fat consumed improves the body's sensitivity to insulin.
Implementation of individualized nutrition therapy advises the use of specific strategies for people with diabetes. The most critical aspect is portion control of all foods to choose nutrient-dense, high fiber foods, select leaner protein sources and meat alternatives, and substitute food with high unsaturated liquid oils. Contrary to the beliefs of many, vitamin and mineral supplements with herbal products or cinnamon is not recommended. The Sodium intake should also be limited to 2300mg daily (Evert et al., 2014). When it comes to alcohol, the consumption must either be stopped or limited to one drink per day. The endorsement requires people with diabetes to take a moderate amount of carbohydrate and to avoid skipping meals.
To individualize strategies for people with diabetes, the current eating patterns and metabolic goals have to be determined. After that, the individual's nutrition therapy goals are set to come up with meal plans based on personal and cultural preferences. The outcomes must then be monitored and adjusted over time to understand effects of life circumstance and disease course (Evert et al., 2014).
The ADA research based on evidence-based practice backs nutrition therapy as an effective means of managing diabetes and prevention for those with pre-diabetes. In conclusion, the goals of nutrition therapy are to provide desired glucose levels and healthy blood pressure. The individual must also be willing to work with the medical practitioners and dietary recommendations by adjusting lifestyle (American Diabetes Association, 1997). Diabetes nutrition education is needed to help the patients understand the extent to which this therapy is efficient, economical, and helps to improve the life of the patients. People with family history of diabetes also have to adopt nutrition therapy as a preventive measure.
American Diabetes Association. (1997). Translation of the diabetes nutrition recommendations for healthcare institutions. Diabetes Care, 20(1), 106.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 37(Supplement 1), S120-S143.
Franz, M. J., Boucher, J. L., & Evert, A. B. (2014). Evidence-based diabetes nutrition therapy recommendations are effective: the key is individualization. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 65.
Franz, M. J. (2016). Diabetes nutrition therapy: Effectiveness, macronutrients, eating patterns and weight management. The American journal of the medical sciences, 351(4), 374-379.
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