Diabetes Type 1 and 2

DM: Scope of Guideline (2008)

Disease/Condition(s)

The purpose of this guideline is to provide evidence-based recommendations for effective medical nutrition therapy (MNT) in the management of type 1 and type 2 diabetes in adults. This guideline is intended for use by Registered Dietitians (RD) involved in providing MNT for this population. Recommendations have been formulated based on current science and provide information on individualized and group nutrition therapy. The major focus of this guideline is on nutrition assessment, nutrition interventions and nutrition monitoring and evaluation, which promote positive clinical outcomes for type 1 and 2 diabetes.

Below, you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Category  

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Treatment

Clinical Specialty

Endocrinology, Family Practice, Nutrition

Intended Users

 Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Pharmacists, Physician Assistants, Physicians, Students

Guideline Objective(s)

Overall Objective
  • To provide MNT guidelines for type 1 and type 2 diabetes that assist in the normalization and maintenance of glycemia, lipid profiles, and blood pressure.
Specific Objectives
  • To define evidence-based diabetes nutrition recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional and behavioral strategies
  • To reduce variations in practice among RDs
  • To promote self-management strategies that empower the adult with diabetes to take responsibility for day-to-day management
  • To provide the RD with data to make recommendations to adjust MNT or recommend other therapies to achieve desired outcomes
  • To enhance the quality of life for the adult with diabetes, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop guidelines for interventions that have measurable clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

 Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults with type 1 or type 2 diabetes.

Interventions and Practices Considered

 

This guideline is based on ADA’s Nutrition Care Process and Model, which involves the following steps:
  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Nutrition Monitoring and Evaluation.
This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.
 

I.  Referral to a Registered Dietitian
II. Medical Nutrition Therapy

A.     Nutrition Assessment

Below you will find the nutrition assessment terms related to diabetes care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition.

1.      Client history
  • Medical/health history
  • Medication and supplement history
  • Social history
  • Personal history
2.      Biochemical data—relevant laboratory values
3.      Anthropometric measurements
  • Height, weight and BMI, waist circumference
  • Weight change rate
4.      Food/nutrition history
  • Food intake
  • Nutrition and health awareness
  • Physical activity and exercise
  • Food availability
  • Psychosocial and economic issues impacting nutrition therapy
  • Consideration of co-morbid conditions and need for additional modifications in nutrition care plan
5.      Physical examination findings

B.     Nutrition Diagnosis

Below you will find the nutrition diagnoses related to diabetes care from International Dietetics & Nutrition Terminology Reference Manual:Standardized Language for the Nutrition Care Process, Second Edition.
  • Inadequate energy intake (NI-1.4)
  • Excessive energy intake (NI-1.5)
  • Excessive alcohol intake (NI-4.3)
  • Excessive fat intake (NI-5.1.2)
  • Inappropriate intake of food fats—specify (NI-5 1.3)
  • Excessive protein intake (NI-5 2.1)
  • Inadequate carbohydrate intake (NI-5 3.1)
  • Excessive carbohydrate intake (NI-5 3.2)
  • Inappropriate intake of types of carbohydrate—specify (NI-5.3.3)
  • Inconsistent carbohydrate intake (NI-5.3.4)
  • Inadequate fiber intake (NI-5.3.5)
  • Altered GI function (NC-1.4)
  • Altered nutrition-related laboratory value (i.e. glucose) (NC-2.2)
  • Food medication interaction (NC-2.3)
  • Underweight (NC-3.1)
  • Involuntary weight loss (NC-3.2)
  • Overweight/obesity (NC-3.3)
  • Involuntary weight gain (NC-3.4)
  • Food- and nutrition-related knowledge deficit (NB-1.1)
  • Not ready for diet/lifestyle change (NB-1.3)
  • Disordered eating pattern (NB-1.5)
  • Limited adherence to nutrition-related recommendations (NB-1.6)
  • Physical inactivity (NB-2.1)
  • Inability or lack of desire to manage self-care (NB-2.3)
  • Impaired ability to prepare foods/meals (NB-2.4)
C.     Nutrition Intervention (Planning and Implementation)
Individualized prescription based on:
1.      Food/Nutrition Intervention
2.      Physical activity Interventions
3.      Behavioral Interventions
4.      Pharmacotherapy, when indicated
Below you will find the nutrition interventions related to diabetes care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition.
  • General/healthful diet (ND-1.1)
  • Modify distribution, type, or amount of food and nutrients within meals or at specified time (ND-1.2)
  • Specific foods/beverages (ND-1.3)
  • Initiate/change nutrition-related medication (ND-6.1 and ND-6.2)
  • Initial/brief nutrition education (E-1.1, E-1.2, E-1.3)
  • Comprehensive nutrition education (E-2.1, E-2.2, E-2.3, E-2.4, E-2.5)
  • Nutrition counseling (C-1, 2, C-1.3, C-1.4, C-1.5)
  • Strategies (C-2.1, C-2.2, C-2.3, C-2.4, C-2.5, C-2.6, C-2.7, C-2.8, C-2.9, C-2.10)
  • Coordination of nutrition care (RC-1.1, RC-1.2, RC-1.3, RC-1.4)
D.    Monitoring and Evaluation
 
The monitoring or progress, measuring of outcomes, and evaluating of outcomes against criteria to determine changes in specific indicators of MNT outcomes.

Although diabetes MNT has the greatest impact at initial diagnosis, it continues to be effective at any time during the disease process. Outcomes resulting from nutrition interventions are known in six weeks to three months and evaluation should be done at these times. At three months, if no clinical improvement has been seen in glycemic control or other metabolic outcomes, the RD needs to recommend a change in medication(s).

Below you will find the nutrition monitoring and evaluation terms related to diabetes care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition.

Nutrition-related behavioral-environmental outcomes (BE-1, BE-2, BE-3, BE-4)
  • Food and nutrient intake outcomes (FI-1)
  • Nutrition-related physical sign/symptoms outcomes (S-1, S-2)
  • Nutrition-related patient/client centered outcomes (PC-1)