#DiabetesAwarenessMonth

Reduce your risk today: Eat healthy, Walk more and Weigh less

Lifestyle modification for prevention of diabetes mellitus

Structured programs that emphasize lifestyle changes for preventing diabetes are recommended by the American Diabetes Association (ADA) for people at high risk for developing type 2 diabetes. These include:

• Dietary strategies including low intake of dietary fat and reduced calories
• Regular physical activity (150 min/week)
• Moderate weight loss (7% body weight)

Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fibre (14 g fibre/1,000 kcal) and foods containing whole grains (one-half of grain intake). Low–glycaemic index foods that are rich in fibre and other important nutrients are to be encouraged.

Medical nutrition therapy

Medical nutrition therapy (MNT) is a therapeutic approach for treatment of medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a medical doctor, registered dietitian or professional nutritionist.

MNT goals for prevention of diabetes

• Goals of nutrition therapy for individuals at risk for diabetes or with pre-diabetes

Decrease the risk of diabetes and cardiovascular disease (CVD) by promoting healthy food choices and physical activity leading to moderate weight loss that is maintained.

• Goals of nutrition therapy that apply to individuals with diabetes

1.  Maintenance of

• Blood glucose levels in the normal range or as close to normal as is safely possible
• Lipid profile that reduces the risk for vascular disease
• Blood pressure levels in the normal range or as close to normal as is safely possible

1. Prevention of, or decrease in, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle.
2. Consideration of individual nutrition needs and personal preferences with willingness to change.
3. Maintenance of the pleasure of eating by only limiting food choices as indicated by scientific evidence.

• Goals of MNT applicable to specific situations

1. For youth with type 1 diabetes, or type 2 diabetes, pregnant and lactating women, and older adults with diabetes, meeting the nutritional needs for such specific times is important.
2. For patients being treated with insulin or insulin-stimulating medication, self-management training is essential for safe conduct of exercise, including the prevention and treatment of hypoglycaemia, and diabetes treatment during acute illness.

Significance of weight loss in pre-diabetes and diabetic conditions

• Weight loss is recommended for all such individuals who have or are at risk for diabetes. In obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance.
• Physical activity, exercise and behaviour modification are important and most helpful in reducing body-weight.
• For weight management, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year).
• For patients on low-carbohydrate diets, monitoring of lipid profiles, renal function, and protein intake (in those with nephropathy), and adjustment of hypoglycaemic therapy is recommended.
• Weight loss medications may be considered in the treatment of overweight type 2 diabetes patients and can help achieve 5–10% weight loss when combined with lifestyle modification.
• Bariatric surgery may be considered for some individuals with type 2 diabetes and BMI ≥35 kg/m2 and can result in marked improvements in glycaemia.

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