Evidence-based medical nutrition therapy for diabetes.

The 2002 American Diabetes Association (ADA) nutrition principles and recommendations are classified according to the level of evidence available using the ADA evidence grading system. Research also supports medical nutrition therapy (MNT) as an effective therapy in reaching treatment goals for glycemia, lipids, and blood pressure. Recommendations for carbohydrate, protein, dietary fat, micronutrients, and alcohol are summarized. The first priority for persons requiring insulin therapy is to identify a food/meal plan that can be used to integrate an insulin regimen into the person's lifestyle. MNT for type 2 diabetes progresses from prevention of obesity or weight gain to improving insulin resistance to contributing to improved metabolic control. The progressive decline in beta-cell failure requires that MNT progress from MNT as monotherapy to MNT in combination with oral glucose-lowering agents to MNT with insulin therapy. Monitoring of outcomes is essential to assess the outcomes of lifestyle interventions or to determine if changes in medication(s) are necessary.