J Clin Outcomes Manage
Medical nutrition therapy for the management of diabetes
Vetter ML, Volger S
Abstract Objective: To provide a comprehensive review of the most recent recommendations for the use of medical nutrition therapy (MNT) in patients with diabetes. Methods: Review of the literature. Results: MNT is an effective adjunct therapy for individuals with diabetes and is associated with a 1% to 2% reduction in HbA1C. As weight loss is an integral component of the chronic management of type 2 diabetes, an energy-restricted diet is recommended. No optimal macronutrient distribution has been found to be efficacious for glycemic control or weight loss. A comprehensive program of lifestyle modification, comprised of diet, physical activity, and behavior therapy, induces a mean loss of 7% to 10% of initial weight in obese individuals with pre-diabetes or diabetes. Two trials demonstrated that weight loss of this magnitude, combined with increased physical activity, substantially reduced the risk of developing type 2 diabetes in individuals with impaired glucose tolerance. A third trial is now investigating whether a lifestyle intervention will reduce cardiovascular morbidity and mortality in overweight individuals who already have diabetes. Pharmacotherapy is recommended, in appropriate patients, as an adjunct to lifestyle modification. Two medications—orlistat and sibutramine—are currently approved in the United States for long-term weight loss. Both are efficacious when combined with lifestyle modification, although recent health concerns have been raised about sibutramine. Conclusion: To complement the medical management of diabetes, providers should be familiar with the underlying principles of MNT.
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