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This article discusses nutrition therapy for adults with diabetes. The American Diabetes Association (ADA) has recommended self-management, education and treatment planning with a health care provider for individuals with diabetes. Goals of nutrition therapy that apply to adults with diabetes include promoting and supporting healthful eating patterns.

The article discusses several nutrition therapy methods for diabetes management in adults. It says that determining which food to eat is the most challenging aspect of a diabetes treatment plan. It cites various aims of nutrition therapy which include promoting healthy eating patterns, achieving individualized blood pressure levels, and addressing personal nutrition needs. It suggests referring a diabetic to a registered dietitian (RD) for nutrition therapy at diagnosis.

The article discusses a systematic review of literature on the role of macronutrients, eating patterns and foods on diabetes management. Medical nutrition therapy (MNT), which is said to be an effective way to manage diabetes, maintains optimal blood glucose levels and prevent and treat the complications of the disease. The researchers searched the PubMed database using various terms that include diabetes, low-fat diet and omega-3 fatty acid.

Background: The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes. Methods: From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c. Results: Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [±SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m². Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly. Conclusion: The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication. [ABSTRACT FROM AUTHOR]

A response to a comment by M. I. Maiorino et al., on the article "A Very Low-Carbohydrate (LC), Low-Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial," by J. Tay et al., is presented. The study authors says that Maiorino et al., correctly determined that HbA1c was the basic result of the past reported study.

A response from the authors of the article "Nutrition Therapy Recommendations for the Management of Adults With Diabetes" in the 2013 issue is presented.