Preface/Acknowledgments

Medical nutrition therapy (MNT) is an evidence-based application of the Nutrition Care Process (nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation) provided by registered dietitian nutritionists (RDN). Nutrition therapy is the treatment of a disease or condition through the modification of nutrient or whole-food intake. As new discoveries in the science of nutrition and diabetes are reported, MNT and nutrition therapy, if needed, evolve. In 1971, the American Diabetes Association published its first report on diabetes nutrition recommendations.¹  These recommendations have been updated in six position statements,^2-7  two technical reviews,^8,9  and a systematic review.¹⁰  A summary of the position statements is also incorporated into the annual American Diabetes Association Standards of Medical Care in Diabetes. The 1994 recommendations perhaps drew the most attention from the public when it was reported that it is the total amount, not the type, of carbohydrate that affects blood glucose levels, and sugary foods could be substituted for starchy foods. Additionally, prior to the 1994 recommendations, all position statements attempted to identify an “ideal” nutrition prescription with ideal percentages of carbohydrate, protein, and fat intake that would apply to everyone with diabetes. Although the need for individualization was stressed in all prior position papers, nutrition prescriptions—which were commonly given by physicians, for specific calorie levels and/or percentages of macronutrients—really did not allow for much, if any, individualization. The 1994 position statement recommended that individualized nutrition prescriptions be based on metabolic profiles, treatment goals, and perhaps most importantly, the changes that the person with diabetes is willing and able to make.⁴ 

The Academy of Nutrition and Dietetics published its first set of nutrition practice guidelines for type 2 and type 1 diabetes in 1995 and 1998, respectively.^11,12  Both sets of guidelines were field tested in randomized clinical trials and shown to be effective.^13,12  Updates were published in 2001¹⁴  and 2010.¹⁵  The Academy of Nutrition and Dietetics’s recent publication Diabetes Type 1 and 2 Evidence-Based Nutrition Practice Guideline for Adults, 2015 can be found in the Academy’s Evidence Analysis Library (EAL)¹⁶  and at the time of writing this Preface have been submitted for publication.^17,18  MNT has repeatedly been shown to be effective and essential in the prevention of diabetes and in the management of diabetes and its complications. However, just as there is no one medication or insulin therapy regimen that works for all people with diabetes, there is no one nutrition therapy intervention that applies to all people with diabetes. One goal of this book, American Diabetes Association Guide to Nutrition Therapy for Diabetes, is to assist health-care providers in the selection of appropriate individualized nutrition therapy interventions.

The 1999 and 2012 editions of American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes^19,20  served as the basis for this edition. This guide is intended to serve as a resource for all health professionals interested in the evidence supporting nutrition therapy interventions—not just for macro- and micronutrients, but for all the related areas of diabetes management in which nutrition therapy is essential.

For this edition, the authors were asked to update general information in their chapters; however, specific steps were used to update the nutrition therapy evidence and recommendations in each chapter. First, the question(s) to be reviewed were stated. Usual first and second questions were: Is nutrition therapy for diabetes effective in this situation? And, if effective, what specific nutrition interventions are effective? Second, search terms and types of studies to review were selected and a literature search conducted. Very importantly, study inclusion criteria needed to be determined and clearly stated. Studies that met inclusion criteria were then incorporated into tables with a concise summary of the studies. Third, the authors were asked to review not only the intent of each study but what the study participants were actually able to achieve related to changes in usual eating patterns. Finally, from these study reviews, conclusion statements and nutrition therapy recommendations were written.

It has been an honor and a pleasure to edit this text. We are truly indebted to the talented chapter authors for the thoroughness and thoughtfulness given to the writing of their chapters. They truly represent the many excellent clinicians and researchers interested in the field of diabetes nutrition therapy. We also thank the reviewers for their excellent suggestions and comments. A special thanks to Victor Van Beuren, our acquisitions editor, who kept us on target and committed to the proposed timeline, and Lauren Wilson, Manager of Book Editing, for her outstanding attention to detail. We’d also like to thank Sacha Uleman, Director of Nutrition, for her thoughtful review. And, of course, thank you to the American Diabetes Association for its ongoing recognition of the integral role of nutrition therapy in the treatment of diabetes, and its dedication to providing professionals with the latest available evidence.