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obic and resistance exercise (107,110,111)\nas well as to establish healthy eating pat-terns. Services delivered by health careprofessionals familiar with diabetes and itsmanagement, such as an RDN, have been\nfound to be effective (102).\nFor many individuals with overweight\nand obesity with type 2 diabetes, 5% | [
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and obesity with type 2 diabetes, 5%\nweight loss is needed to achieve bene fi-\ncial outcomes in glycemic control, lipids,\nand blood pressure (112,113). It should\nbe noted, however, that the clinical ben-efits of weight loss are progressive, and\nmore intensive weight loss goals (i.e.,\n15%) may be appropriate to maxi... | [
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15%) may be appropriate to maximize\nbene fit depending on need, feasibility,\nand safety (114,115). Long-term durabil-ity of weight loss remains a challenge;\nhowever, newer medications (beyond\nmetabolic surgery) may have potentialfor sustainability, impact on cardiovas-cular outcomes, and weight reduction\nbeyond 10 ... | [
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beyond 10 –15% (116– 120).\nIn select individuals with type 2 diabe-\ntes, an overall healthy eating plan that re-\nsults in energy defi cit in conjunction with\nweight loss medications and/or metabolic\nsurgery should be considered to help | [
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surgery should be considered to help\nachieve weight loss and maintenancegoals, lower A1C, and reduce CVD risk(108,121,122). Overweight and obesityare also increasingly prevalent in people\nwith type 1 diabetes and present clinical | [
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with type 1 diabetes and present clinical\nchallenges regarding diabetes treatmentS80 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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Table 5.1 —Medical nutrition therapy recommendations\nRecommendations\nEffectiveness of nutrition therapy 5.9An individualized medical nutrition therapy program as needed to achieve treatment | [
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goals, provided by a registered dietitian nutritionist, preferably one who has compre-hensive knowledge and experience in diabetes care, is recommended for all peoplewith type 1 or type 2 diabetes, prediabetes, and gestational diabetes mellitus. A\n5.10 Because diabetes medical nutrition therapy can result in cost savi... | [
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cardiometabolic outcomes, Amedical nutrition therapy should be adequately reim-\nbursed by insurance and other payers. E\nEnergy balance 5.11 For all people with overweight or obesity, behavioral modi fication to achieve and\nmaintain a minimum weight loss of 5% is recommended. A | [
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maintain a minimum weight loss of 5% is recommended. A\nEating patterns and macronutrient distribution 5.12 For diabetes prevention and management of people with prediabetes or diabetes,\nrecommend individualized meal plans that keep nutrient quality, total calories, and | [
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metabolic goals in mind, Bas data do not support a speci fic macronutrient pattern.\n5.13 Food-based dietary patterns should emphasize key nutrition principles (inclusion ofnonstarchy vegetables, whole fruits, legumes, whole grains, nuts/seeds, and low-fatdairy products and minimizing consumption of meat, sugar-sweetene... | [
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sweets, re fined grains, and ultraprocessed foods) in people with prediabetes and dia-\nbetes. B\n5.14 Consider reducing overall carbohydrate intake for adults with diabetes to improve\nglycemia, as this approach may be applied to a variety of eating patterns that meet\nindividual needs and preferences. B | [
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individual needs and preferences. B\nCarbohydrates 5.15 Emphasize minimally processed, nutrient-dense, high- fiber sources of carbohydrate\n(at least 14 g fiber per 1,000 kcal). B\n5.16 People with diabetes and those at risk are advised to replace sugar-sweetened bev- | [
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erages (including fruit juices) with water or low-calorie or no-calorie beverages asmuch as possible to manage glycemia and reduce risk for cardiometabolic disease B\nand minimize consumption of foods with added sugar that have the capacity to dis-\nplace healthier, more nutrient-dense food choices. A | [
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place healthier, more nutrient-dense food choices. A\n5.17 Provide education on the glycemic impact of carbohydrate, Afat, and protein B\ntailored to an individual ’s needs, insulin plan, and preferences to optimize mealtime\ninsulin dosing.\n5.18 When using fixed insulin doses, individuals should be provided with educa... | [
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consistent patterns of carbohydrate intake with respect to time and amount while\nconsidering the insulin action time, as it can result in improved glycemia and reduce\nthe risk for hypoglycemia. B | [
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the risk for hypoglycemia. B\nProtein 5.19 For people with type 2 diabetes, consider avoiding carbohydrate sources high in pro-tein when treating or preventing hypoglycemia, as ingested protein appears to in-\ncrease insulin response without increasing plasma glucose concentrations. B | [
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0.011571192182600498,
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0.0384415... |
Dietary fat 5.20 Counsel people with diabetes to consider an eating plan emphasizing elements of a\nMediterranean eating pattern, which is rich in monounsaturated and polyunsatu-\nrated fats and long-chain fatty acids such as fatty fish, nuts, and seeds, to reduce\ncardiovascular disease risk Aand improve glucose metabo... | [
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0.033287230879068375,
0.0060754986479878426,
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0.00215180148370564,
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0.019393406808376312,
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Micronutrients and herbal supplements 5.21 Dietary supplementation with vitamins, minerals (such as chromium and vitamin D),herbs, or spices (such as cinnamon or aloe vera) are not recommended for glycemicbene fits. Health care professionals should inquire about intake of supplements and\ncounsel as needed. C | [
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counsel as needed. C\n5.22 Counsel against b-carotene supplementation, as there is evidence of harm for certain\nindividuals and it confers no bene fit.B\nAlcohol 5.23 Advise adults with diabetes who consume alcohol to not exceed the recommended daily\nlimits (one drink per day for adult women and two drinks per day for... | [
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Advise abstainers to not start to drink, even in moderation, solely for the purpose of im-\nproving health outcomes. C | [
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proving health outcomes. C\n5.24 Educating people with diabetes about the signs, symptoms, and self-management ofdelayed hypoglycemia after drinking alcohol, especially when using insulin or insulinsecretagogues, is recommended. The importance of monitoring glucose after drinking | [
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alcoholic beverages to reduce hypoglycemia risk should be emphasized. B\nSodium 5.25 Counsel people with diabetes to limit sodium consumption to <2,300 mg/day. B\nNonnutritive sweeteners 5.26 Counsel people with prediabetes and diabetes that water is recommended over nu-\ntritive and nonnutritive sweetened beverages. H... | [
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sweeteners as a replacement for sugar-sweetened products in moderation is accept-\nable if it reduces overall calorie and carbohydrate intake. Bdiabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S81\n©AmericanDiabetesAssociation | [
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and CVD risk factors (123,124). Sustaining\nweight loss can be challenging (112,125)\nbut has long-term bene fits; maintaining\nweight loss for 5 years is associated withsustained improvements in A1C and lipid\nlevels (126). MNT guidance from an RDN\nwith expertise in diabetes and weightmanagement throughout the course ... | [
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structured weight loss plan is strongly\nrecommended.\nAlong with routine medical management\nvisits, people with diabetes and prediabetesshould be screened during DSMES andMNT encounters for a history of dieting and\npast or current disordered eating behaviors.\nNutrition therapy should be individualized\nto help addr... | [
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to help address maladaptive eating behav-\nior (e.g., purging) or compensatory changesin medical treatment plan (e.g., overtreat-\nment of hypoglycemic episodes and re-\nd u c t i o ni nm e d i c a t i o nd o s i n gt or e d u c e\nhunger) (73) (see\nDISORDERED EATING BEHAVIOR , | [
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hunger) (73) (see\nDISORDERED EATING BEHAVIOR ,\nbelow). Disordered eating, eating disor-ders, and/or disrupted eating can in-\ncrease challenges for weight and diabetesmanagement. For example, caloric restric-\ntion may be essential for glycemic man-\nagement and weight maintenance, but\nrigid meal plans may be contra... | [
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rigid meal plans may be contraindicated\nfor individuals who are at increased riskof clinically signi ficant maladaptive eating\nbehaviors (127). If eating disorders areidenti fied during screening with diabetes-\nspecifi c questionnaires, individuals should\nbe referred to a quali fied behavioral\nhealth professional (1). | [
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be referred to a quali fied behavioral\nhealth professional (1).\nStudies have demonstrated that a vari-\nety of eating plans, varying in macronutri-ent composition, can be used effectively\nand safely in the short term (1 –2y e a r s )t o\nachieve weight loss in people with diabe-\ntes. These plans include structured l... | [
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tes. These plans include structured low-\ncalorie meal plans with meal replacements\n(114,126,128), a Mediterranean eating\npattern (129), and low-carbohydrate meal\nplans with additional support (130,131).\nHowever, no single approach has been\nproven to be consistently superior (73,132–134), and more data are needed ... | [
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identify and validate those meal plansthat are optimal with respect to long-\nterm outcomes and acceptability. Any\napproach to meal planning should be in-dividualized, considering the health sta-\ntus, personal and cultural preferences,\nhealth goals, ability to sustain the recom-\nmendations, and ultimately food acce... | [
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mendations, and ultimately food access\nand nutrition security (73).Food Insecurity and Access\nFood insecurity is de fined as a lack of con-\nsistent access to enough food for an active,\nhealthy life (135). Food insecurity affects\n16% of adults with diabetes compared\nwith 9% of adults without diabetes (136). | [
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with 9% of adults without diabetes (136).\nThere is a complex bidirectional associationbetween food insecurity and cooccurring\ndiabetes. Food security screening should\nhappen at all levels of the health care sys-\ntem. Any member of the health care team\ncan screen for food insecurity using The\nHunger Vital Sign. Ho... | [
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Hunger Vital Sign. Households are consid-\nered at risk if they answer either or both ofthe following statements as “often true ”or\n“sometimes true ”(compared with “never\ntrue”) (137):\n\x81“Within the past 12 months, we wor-\nried whether our food would run outbefore we got money to buy more. ”\n\x81“Within the past... | [
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\x81“Within the past 12 months, the\nfood we bought just didn’ t last, and\nwe didn’ t have money to get more. ”\nIf screening is positive for food insecurity,\nefforts should be made to make referrals to\nappropriate programs and resources. For\nmore information on efforts and policy rec-\nommendations, see “The Biden... | [
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ommendations, see “The Biden-Harris Ad-\nministration National Strategy on Hunger,Nutrition, and Health ”(138).\nEating Patterns and Meal Planning\nFor an understanding of nutrition and di-\nabetes, it is important to clarify the dif-\nferences between food patterns, eating\nplans, and approaches. These are termsthat a... | [
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they are different and relevant in individ-\nualizing nutrition care plans (139).\n\x81Eating pattern(s) or food pattern(s).\nThe totality of all foods and beverages\nconsumed over a given period of time.\nAn eating pattern can be ascribed to an\nindividual, but it is also the term usedin prospective cohort and observa... | [
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nutrition studies to classify and study\nnutrition patterns. Examples of eating\npatterns include Mediterranean style,\nDietary Approaches to Stop Hyperten-\nsion (DASH), low-carbohydrate vegetar-\nian, and plant based (139).\n\x81Eating/meal plan (historically referred\nto as a diet). An individualized guide to\nhelp ... | [
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help plan when, what, and how much\nto eat on a daily basis, completed by\nt h ep e r s o nw i t hd i a b e t e sa n dt h eR D N .The eating plan could incorporate an\neating pattern combined with a strat-egy or method to direct some of thechoices. Eating plans are based on the\nindividual ’s usual eating style.\n\x81D... | [
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\x81Dietary approach. Method or strategy\nto individualize a desired eating pattern\nand provide a practical tool(s) for devel-\noping healthy eating patterns. Examples\nof dietary approaches include the platemethod, carbohydrate choice, carbohy-drate counting, and highly individual-\nized behavioral approaches (140). | [
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ized behavioral approaches (140).\nEvidence suggests that there is not an\nideal percentage of calories from carbo-\nhydrate, protein, and fat for people withdiabetes. Therefore, macronutrient distri-\nbution should be based on an individual- | [
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bution should be based on an individual-\nized assessment of current eating patterns,preferences, and metabolic goals. Mem-bers of the health care team should com-\nplement MNT by providing evidence-based\nguidance that helps people with diabetesmake healthy food choices that meet their\nindividualized needs and improv... | [
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individualized needs and improve overall\nhealth.\nResearch con firms that a variety of eat-\ning patterns are acceptable for the man-agement of diabetes (73,104,141,142).\nUntil the evidence around bene fits of dif-\nferent eating patterns is strengthened,\nhealth care professionals should focus onthe core dimensions co... | [
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terns: inclusion of nonstarchy vegetables,\nwhole fruits, legumes, whole grains, nuts,seeds, and low-fat dairy products and\nminimizing consumption of meat, sugar-\nsweetened beverages, sweets, re fined\ngrains, and ultraprocessed foods (143,144).\nEvidence for eating patterns has been\ninformed by RCTs, prospective coh... | [
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informed by RCTs, prospective cohort\nstudies, systematic reviews, and network\nmeta-analysis. Those most frequentlyreferenced include Mediterranean, DASH,\nlow-fat, carbohydrate-restricted, vegetarian,\nand vegan eating patterns. As stated previ-ously, there is insuf ficient evidence to select\none over the other (137,... | [
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one over the other (137,141,142,145 –154).\nUltimately, ongoing diabetes and nutritioneducation paired with appropriate supportto implement and sustain health behaviorsis recommended (103).\nMeal Planning\nReferral to and ongoing support from anRDN is essential to assess the overall nu-trition status of, and to work co... | [
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tively with, the person with diabetes to\ncreate a personalized meal plan thatS82 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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coordinates and aligns with the overall\nlifestyle treatment plan, including physical\nactivity and medication use. Using shared\ndecision-making to collaboratively selecta method for how to execute the planmay be part of the nutrition care process.\nDietary Approaches/Methods | [
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Dietary Approaches/Methods\nFew head-to-head studies have compareddifferent dietary approaches. In a system-atic review and meta-analysis of carbohy-drate counting versus other forms ofdietary advice (standard education, lowglycemic index, and fixed carbohydrate\nquantities), no signi ficant differences were | [
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quantities), no signi ficant differences were\nseen in A1C levels compared with stan-dard education (145). In another RCT,as i m p l i fied carbohydrate counting tool\nbased on individual glycemic response was\nnoninferior to conventional carbohydrate | [
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counting in 85 adults with type 1 diabetes(146). In a randomized crossover trial, car-bohydrate counting and qualitative mealsize (low, medium, and high carbohydrate)were compared. Time in range was 74%for carbohydrate counting and 70.5% forthe quantitative meal size estimates. Non-inferiority was not con firmed for the... | [
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tative method (147). Newer technologies(smart phone apps and CGM), includingautomated insulin delivery, may decreasethe need for precise carbohydrate count-ing and allow for personalized nutrition ap-proaches (148,149).\nAn RCT found that two meal-planning | [
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approaches (diabetes plate method andcarbohydrate counting) were effective inhelping achieve improved A1C (150). Thediabetes plate method is a commonlyused visual approach for providing basicmeal planning guidance in type 1 andtype 2 diabetes. This simple graphic (fea-turing a 9-inch plate) shows how to por-tion foods ... | [
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a 9-inch plate) shows how to por-tion foods (one-half of the plate fornonstarchy vegetables, one-quarter ofthe plate for protein, and one-quarter ofthe plate for carbohydrates). Carbohy-drate counting is a more advanced skillthat helps plan for and track how muchcarbohydrate is consumed at meals andsnacks. Meal plannin... | [
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is consumed at meals andsnacks. Meal planning approaches shouldbe customized to the individual, includingtheir numeracy (150) and food literacylevel. Health numeracy refers to under-standing and using numbers and numericalconcepts in relation to health and self-management (155). Food literacy generallydescribes pro fici... | [
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edge and skills that ultimately impact health,although specifi cd efinitions vary across ini-\ntiatives (151,152).\nIntermittent fasting or time-restricted\neating as strategies for weight and glu-\ncose management have been studied\nand have gained popularity. Intermittent | [
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and have gained popularity. Intermittent\nfasting is an umbrella term that includesthree main forms of restricted eating: al-ternate-day fasting (energy restriction of500–600 calories on alternate days), the\n5:2 diet (energy restriction of 500 – | [
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5:2 diet (energy restriction of 500 –\n600 calories on consecutive or noncon-secutive days with usual intake the otherfive), and time-restricted eating (daily\ncalorie restriction based on window of timeof 8–15 h). Each produces mild to moder-\nate weight loss (3 –8% loss from baseline)\nover short durations (8– 12 week... | [
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over short durations (8– 12 weeks) with no\nsignificant differences in weight loss when\ncompared with continuous calorie restric-tion (153,154,156,157). A few studies haveextended up to 52 weeks and show similarfindings (158 –162) with diverse popula- | [
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tions. Generally, time-restricted eating orshortening the eating window can beadapted to any eating pattern and hasbeen shown to be safe for adults with\ntype 1 or type 2 diabetes (161). People\nwith diabetes who are on insulin and/orsecretagogues should be medically moni-tored during the fasting period (163). Be- | [
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cause of the simplicity of intermittent\nfasting and time-restricted eating, thesemay be useful strategies for people withdiabetes who are looking for practical eat-ing management tools.\nUse of partial meal replacements or to- | [
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Use of partial meal replacements or to-\ntal meal replacements is an additionaltool or strategy for energy restriction.Meal replacements are prepackaged foods(bars, shakes, and soups) that contain a\nfixed amount of macroutrients and mi-\ncronutrients. They have been shown to\nimprove nutrient quality and glycemicmanage... | [
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and consequent energy intake. In a meta-\nanalysis involving 17 studies incorporatingboth partial and total meal replacements,greater weight loss and improvement in\nA1C and fasting blood glucose were dem- | [
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A1C and fasting blood glucose were dem-\no n s t r a t e dc o m p a r e dw i t hc o n v e n t i o n a ld i -ets (164). Meal replacements have beenused in several landmark clinical trials, in-cluding Look AHEAD (Action for Health in\nDiabetes) (165), DiRECT (Diabetes Remis- | [
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Diabetes) (165), DiRECT (Diabetes Remis-\nsion Clinical Trial) (166), and PREVIEW (Pre-vention of Diabetes Through LifestyleIntervention and Population Studies in\nEurope and Around the World) (167),\nshowing partial or total meal replacementscan be a potential short-term strategy forweight loss.\nRegardless of the eat... | [
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-... |
Regardless of the eating pattern, meal\nplan, and/or dietary approach selected,long-term follow-up and support from\nmembers of the diabetes care team are\nneeded to optimize self-ef ficacy and main-\ntain behavioral changes (140).\nChrononutrition is a growing and\nemerging specialty in the field of nutri- | [
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emerging specialty in the field of nutri-\ntion and biology that tries to understandhow the timing of food ingestion affectsmetabolic health (168). Glucose metabo-lism follows a circadian rhythm through\ndiurnal variation of glucose tolerance, | [
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diurnal variation of glucose tolerance,\npeaking during daylight hours when food isconsumed. Some preliminary studies showcardiometabolic bene fits when food is con-\nsumed earlier (169). Similarly, circadian dis-ruptions found in shift workers increaserisk of type 2 diabetes (170). Althoughmore research needs to be don... | [
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evolving area of research may show prom-\nise to improve glucose regulation.\nReligious Fasting\nAlthough intermittent fasting and time-restricted eating are speci ficd i e t a r ys t r a t - | [
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egies for energy restriction, religious fast-ing has been practiced for thousands ofyears and is part of many faith-based tra-ditions. Duration, frequency, and type offast vary among different religions (171).\nFor example, Jewish people abstain from\nany intake for /C2424 h during Yom Kippur | [
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any intake for /C2424 h during Yom Kippur\n(172,173). For Muslims, Ramadan fastinglasts for a full month, when abstinence\nfrom any food or drink is required from\ndawn to dusk (174). Individuals with dia-betes who fast have an increased risk forhypoglycemia, dehydration, hyperglyce-\nmia, and ketoacidosis. Risk can va... | [
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mia, and ketoacidosis. Risk can vary de-\npending on the type of diabetes, type oftherapy, and presence and severity of dia-betes-related complications (175). Health\ncare professionals, including RDNs, certi-\nfied DCES, and others, should inquire\nabout any religious fasting for peoplewith diabetes and provide educati... | [
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support to accommodate their choice.\nEducation regarding glucose checking,medication/fl uid adjustment, timing and\nintensity of physical activity, and meal\nchoices pre- and post-fast should be pro-\nvided (176). Treatment pre- and post-fastshould be culturally sensitive and individ-ualized (177). Speci fic recommendat... | [
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for diabetes management during Rama-\ndan (175) and Yom Kippur (172) are\navailable.diabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S83\n©AmericanDiabetesAssociation | [
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Carbohydrates\nStudies examining the optimal amount\nof carbohydrate intake for people with\ndiabetes are inconclusive, although mon-itoring carbohydrate intake is a key strat-\negy in reaching glucose goals in people\nwith type 1 and type 2 diabetes (178,179).\nFor people with type 2 diabetes, low-\ncarbohydrate and v... | [
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carbohydrate and very-low-carbohydrate\neating patterns in particular have been found\nt or e d u c eA 1 Ca n dt h en e e df o ra n t i h y p e r g l y -cemic medications (139,180 –184). System-\natic reviews and meta-analyses of RCTsfound carbohydrate-restricted eating pat-\nterns, particularly those considered low | [
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terns, particularly those considered low\ncarbohydrate ( <26% total energy), were ef-\nfective in reducing A1C in the short term\n(<6 months), with less difference in eating\npatterns beyond 1 year (134,182,185 –187).\nQuestions still remain about the optimal de-gree of carbohydrate restriction and the | [
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long-term effects of those meal patterns onCVD. A systematic review and meta-analysis\nof RCTs investigating the dose-dependent\neffects of carbohydrate restriction foundeach 10% decrease in carbohydrate intake\nhad reductions in levels of A1C, fasting\nplasma glucose, body weight, lipids, andsystolic blood pressure at... | [
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favorable effects diminished and were not\nmaintained at follow-up or at greater than12 months. This systematic review high-\nlights the metabolic complexity of re-\nsponse to dietary intervention in type 2diabetes as well as the need to better un-\nderstand longer-term sustainability and | [
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derstand longer-term sustainability and\nresults (188). Part of the challenge ininterpreting low-carbohydrate research\nhas been due to the wide range of de fini-\ntions for a low-carbohydrate eating plan\n(189,190). Weight reduction was also a\ngoal in many low-carbohydrate studies, | [
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goal in many low-carbohydrate studies,\nwhich further complicates evaluatingthe distinct contribution of the eating\npattern (48,130,134,188). As studies on\nlow-carbohydrate eating plans generallyindicate challenges with long-term sus-\ntainability (180), it is important to reas- | [
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tainability (180), it is important to reas-\nsess and individualize meal plan guidanceregularly for those interested in this ap-\nproach. Health care professionals should\nmaintain consistent medical oversight andrecognize that insulin and other diabetes\nmedications may need to be adjusted to | [
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medications may need to be adjusted to\nprevent hypoglycemia, and blood pressurewill need to be monitored. In addition,\nvery-low-carbohydrate eating plans are\nnot currently recommended for individualswho are pregnant or lactating, children,people who have renal disease, or people | [
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with or at risk for disordered eating, andthese plans should be used with cautionin those taking sodium –glucose cotrans-\nporter 2 inhibitors because of the potential\nrisk of ketoacidosis (191– 193).\nRegardless of the amount of carbohy-\ndrate in the meal plan, focus should be\nplaced on high-quality, nutrient-dense... | [
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... |
placed on high-quality, nutrient-dense car-\nbohydrate sources that are high in fiber\nand minimally processed. The addition of\ndietary fiber modulates composition of\ngut microbiota and increases gut microbialdiversity. Although there is still much to be\nelucidated with the gut microbiome and\nchronic disease, higher-... | [
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chronic disease, higher- fiber diets are ad-\nvantageous (194). Both children and adultswith diabetes are encouraged to minimize\nintake of re fined carbohydrates with\nadded sugars, fat, and sodium and instead\nfocus on carbohydrates from vegetables,legumes, fruits, dairy (milk and yogurt),\nand whole grains. People wit... | [
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and whole grains. People with diabetes\nand those at risk for diabetes are encour-aged to consume a minimum of 14 g of fi-\nber/1,000 kcal, with at least half of grain\nconsumption being whole, intact grains,\naccording to the Dietary Guidelines forAmericans (98). Regular intake of suf ficient\ndietary fiber is associated... | [
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dietary fiber is associated with lower all-\ncause mortality in people with diabetes\n(195,196), and prospective cohort studies\nhave found dietary fiber intake is inversely\nassociated with risk of type 2 diabetes(197– 199). The consumption of sugar-\nsweetened beverages and processed foodproducts with large amounts of ... | [
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grains and added sugars is strongly dis-couraged (98,200,201), as these have the\ncapacity to displace healthier, more nutri-\nent-dense food choices.\nThe literature concerning glycemic in-\ndex and glycemic load in individuals withdiabetes is complex, often with varying\ndefinitions of low- and high-glycemic-\nindex f... | [
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index foods (202,203). The glycemic index\nranks carbohydrate foods on their post-prandial glycemic response, and glycemic\nload takes into account both the glycemic\nindex of foods and the amount of carbohy-drate eaten. Studies have found mixed re-sults regarding the effect of glycemic indexand glycemic load on fastin... | [
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and A1C, with one systematic review find-\ning no signifi cant impact on A1C (204)\nwhile others demonstrated A1C reductions\nof 0.15% (202) to 0.5% (190,205).\nIndividuals with type 1 or type 2 diabe- | [
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Individuals with type 1 or type 2 diabe-\ntes taking insulin at mealtime shouldbe offered comprehensive and ongoingeducation about nutrition content and theneed to couple insulin administration withcarbohydrate intake. For people whosemeal schedule or carbohydrate consump-tion is variable, regular education to in- | [
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crease understanding of the relationship\nbetween carbohydrate intake and insulinneeds is important. In addition, educationon using insulin-to-carbohydrate ratios for\nmeal planning can assist individuals with\neffectively modifying insulin dosing frommeal to meal to improve glycemic man-agement (104,178,206 –208). Stu... | [
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shown that dietary fat and protein can im-pact early and delayed postprandial glyce-mia (209 –212), and it appears to have a\ndose-dependent response (213 –216). Re-\nsults from high-fat, high-protein meal stud-\nies highlight the need for additional insulin | [
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ies highlight the need for additional insulin\nto cover these meals; however, more stud-ies are needed to determine the optimalinsulin dose and delivery strategy. The re-\nsults from these studies also point to indi-\nvidual differences in postprandial glycemicresponse; therefore, a cautious approachto increasing insul... | [
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and/or high-protein mixed meals is recom-\nmended to address delayed hyperglycemiathat may occur after eating (73,217,218). Ifusing an insulin pump, a split bolus feature(part of the bolus delivered immediately,\nthe remainder over a programmed dura- | [
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... |
the remainder over a programmed dura-\ntion of time) may provide better insulincoverage for high-fat and/or high-proteinmixed meals (210,219).\nThe effectiveness of insulin dosing deci-\nsions should be con firmed with a structured\napproach to blood glucose monitoring orCGM to evaluate individual responses andguide ins... | [
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0.0... |
glucose 3 h after eating may help to deter-\nmine if additional insulin adjustments are re-quired (i.e., increasing or stopping bolus)(210,219,220). Adjusting insulin doses to\naccount for high-fat and/or high-protein | [
0.004843129776418209,
-0.01710219867527485,
-0.022366531193256378,
0.03129471465945244,
0.025425175204873085,
-0.008575608022511005,
0.055404044687747955,
-0.014479927718639374,
-0.07713145762681961,
-0.011716082692146301,
-0.009112042374908924,
0.0006217090995050967,
-0.058916572481393814,
... |
account for high-fat and/or high-protein\nmeals requires determination of antici-pated nutrient intake to calculate themealtime dose. Food literacy, numeracy,interest, and capability should be evalu-\nated (73). For individuals on a fixed daily\ninsulin schedule, meal planning should\nemphasize a relatively fixed carbohy... | [
0.051698025315999985,
0.004988841246813536,
-0.009953567758202553,
0.00941877719014883,
-0.030442839488387108,
0.008792689070105553,
0.01637568697333336,
0.03272015228867531,
-0.06432577222585678,
-0.05372204631567001,
0.006508299149572849,
-0.03769715130329132,
-0.0740780308842659,
-0.001... |
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