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During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on “Standards of Medical Care for Patients With Diabetes Mellitus” (last revised October 2003) included “special considerations” for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6). The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus (7). Several excellent detailed guidelines and chapters on type 1 diabetes in pediatric endocrinology texts exist, including those by the International Society of Pediatric and Adolescent Diabetes (ISPAD) (8), by the Australian Pediatric Endocrine Group (www.chw.edu/au/prof/services/endocrinology/apeg), in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13). Children have characteristics and needs that dictate different standards of care. The management of diabetes in children must take the major differences between children of various ages and …

Medical nutrition therapy for people with diabetes should be individualized, with consideration given to the individual's usual food and eating habits, metabolic profile, treatment goals and desired outcomes. Monitoring of metabolic parameters, including glucose, HbA1c, lipids, blood pressure, body weight, and renal function, when appropriate, as well as quality of life is essential to assess the need for changes in therapy and ensure successful outcomes. Ongoing nutrition self-management education and care needs to be available for individuals with diabetes. Additionally many areas of nutrition and diabetes require additional research.

A large proportion of a home care nurse's caseload is elderly persons with diabetes, presenting as either a primary or secondary diagnosis. This article provides specific guidelines for nutritional knowledge and assessment of these clients while giving practical guidelines for nutrition counseling and education.

This article discusses methods for monitoring diabetes therapy. Emphasis is placed on client assessment and selection of appropriate products to ensure accurate results.

Advances in diabetes management and the variety of nutrition care services available to individuals with diabetes make this an exciting time for dietetics professionals to be working in the field of diabetes. Evidence supporting the effectiveness of medical nutrition therapy (MNT) for diabetes management continues to grow, with documented decreases in A1C of 2% in cases of newly diagnosed type 2 diabetes, and of 1% in cases of type 2 diabetes with an average duration of 4 years and in newly diagnosed people with type 1 diabetes (1). These outcomes are highly significant. For example, for a person newly diagnosed with type 2 diabetes who initially has an A1C of 9.0% and sees a registered dietitian for MNT, the expected outcome would be a reduction of A1C to 7.0%, which actually represents a 24% improvement. In January 2002, the American Diabetes Association published an updated position statement, “Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications” (2), along with a technical review that discusses in detail the published research for each principle and recommendation (3). These recommendations replace previous documents written in 1994. Additionally, the American Dietetic Association (ADA) and the Diabetes Care and Education dietetic practice group developed Medical Nutrition Therapy Evidence-Based Guides for Practice—nutrition practice guidelines for type 1 diabetes, type 2 diabetes (4), and gestational diabetes mellitus (5), as well as other diseases. The Centers for Medicare and Medicaid Services requires use of nationally recognized protocols, such as the ADA evidence-based guides for practice, for the Medicare MNT benefit (6). In response to these events, the American Diabetes Association and the ADA initiated a review of the client education pieces they copublish. In early 2002, a Nutrition Publications Advisory Task Force was appointed by the publications departments of the two associations. The charges of this task force were to (a) review existing diabetes nutrition education publications for consumers; (b) evaluate their purpose and clinical usefulness based on actual sales data from the two associations, feedback from staff, and consensus of the experienced members of the task force; and (c) make recommendations to staff for revisions. The primary goal was to ensure that all publications were consistent with the 2002 American Diabetes Association’s nutrition position statement and the ADA evidencebased guides for practice for diabetes care (type 1, type 2, and gestational diabetes).

Historically, nutrition principles and recommendations for diabetes and related complications have been based on scientific evidence and diabetes knowledge when available and, when evidence was not available, on clinical experience and expert consensus. Often it has been difficult to discern the level of evidence used to construct the nutrition principles and recommendations. Furthermore, in clinical practice, many nutrition recommendations that have no scientific supporting evidence have been and are still being given to individuals with diabetes. To address these problems and to incorporate the research done in the past 8 years, this 2002 technical review provides principles and recommendations classified according to the level of evidence available. It reviews the evidence from randomized, controlled trials; cohort and case-controlled studies; and observational studies, which can also provide valuable evidence (1,2), and takes into account the number of studies that have provided consistent outcomes of support. In this review, nutrition principles are graded into four categories based on the available evidence: those with strong supporting evidence, those with some supporting evidence, those with limited supporting evidence and those based on expert consensus. Evidence-based nutrition recommendations attempt to translate research data and clinically applicable evidence into nutrition care. However, the best available evidence must still be moderated by individual circumstances and preferences. The goal of evidence-based recommendations is to improve the quality of clinical judgments and facilitate cost-effective care by increasing the awareness of clinicians and patients with diabetes of the evidence supporting nutrition services and the strength of that evidence, both in quality and quantity. Before 1994, the American Diabetes Association’s (ADA’s) nutrition principles and recommendations attempted to define an “ideal” nutrition prescription that would apply to everyone with diabetes (3,4,5). Although individualization was a major principle of all recommendations, it was usually done within defined …

This article is a brief overview of the incidence, classification, and diagnosis of diabetes mellitus. Current concepts of diabetes management, including nutrition, exercise, and medication, are introduced.