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New Diabetes Nutrition Therapy Recommendations: What You Need to Know

  1. Alison B. Evert, MS, RD, CDE and
  2. Jackie L. Boucher, MS, RD, CDE
Diabetes Spectrum 2014 May; 27(2): 121-130. https://doi.org/10.2337/diaspect.27.2.121

The American Diabetes Association (ADA) has long recognized the integral role of nutrition therapy in overall diabetes management and recommends that each person with diabetes receive an individualized eating plan that has been developed in collaboration with his or her health care provider (HCP).1 To ensure that members of the health care team are providing up-to-date, evidence-based clinical practice recommendations, the ADA issues official position statements on scientific or medical issues related to diabetes. Recently, the ADA published a position statement titled “Nutrition Therapy Recommendations for the Management of Adults With Diabetes.”2 These recommendations replace those in previous position statements. This article reviews the development process for the 2013 nutrition recommendations, shares highlights from those guidelines, and discusses priority topics in the publication.

Trustworthy Clinical Practice Guidelines/Position Statements

The 2013 ADA nutrition statement was written at the request of the ADA Professional Practice Committee. In August 2012, the ADA convened a committee of nutrition experts in clinical practice and research, as well as other members of the diabetes health care team (a registered nurse/advanced practice nurse practitioner, a physician, and a pharmacist) to review the scientific literature and develop recommendations. The multidisciplinary committee followed the Institute of Medicine (IOM) Standards for Trustworthy Clinical Practice Guidelines.3 Based on the IOM standards, conflict of interest disclosures were obtained before confirmation of appointment of the co-chairs and the members of the committee/writing group. Development of the position statement was funded from ADA general revenues and not with any corporate or industry financial support.

Evidence-Based Diabetes Nutrition Therapy: Development of the Recommendations

The committee's work on the position statement began with an introductory conference call. The group reviewed an outline for the statement and assigned sections to specific members. Committee members were instructed to conduct thorough literature searches and create evidence tables for all of the topics included in the statement. Inclusion criteria for research studies providing evidence included:

  • Adult subjects with a diagnosis of diabetes in an ambulatory or outpatient setting

  • Published in English

  • ≥ 10 participants

  • Retention rates > 80%

Study design preference in ascending order included:

  • Systematic review

  • Randomized, controlled trial

  • Clinical controlled study

  • Prospective observational study

  • Cross-sectional observational study

  • Case-control study

View this table:
Table 1.

Evidence Levels

Meal studies were excluded. Other exclusion criteria included research in individuals with:

  • Prediabetes/metabolic syndrome

  • Gestational diabetes/pregnancy

  • Poor health status/diabetes complications or critical illness

The ADA's “Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes: A Systematic Review of the Literature,”4 published in 2012, served as a foundation for development of the new position statement. However, three crucial components of diabetes nutrition therapy were not addressed in this systematic review: effecti