The American Diabetes Association (ADA) has issued new nutritional guidelines that focus on overall dietary patterns and patient preferences, rather than specific dietary prescriptions. Dr. Alison Evert of the University of Washington Medical Center, one of the authors of the guidelines, noted that the guidelines do not intentionally avoid the word “diet” and that the guidelines document refers to “eating plans” or “eating patterns” rather than “diets. “Instead of diet, we want to work with patients and help them reach their health goals. Many dietary patterns are effective, but people prefer to use diet plans. The new evidence-based position statement, “Recommendations for the Nutritional Treatment of Adults with Diabetes” (“the new guidelines”), was published online Oct. 9 in Diabetes Care. The new guidelines review the evidence-based evidence for several common diet plans, including the Mediterranean diet, vegetarian diet, low-fat diet, low-carbohydrate diet, and Dietary Approaches to Prevent Hypertension (DASH), but do not specifically recommend any of them. The new guidelines recommend that a diet plan should be chosen to suit the patient’s personal preferences (including customs, culture, religion, health philosophy and goals, and economic status) and the metabolic goals he or she is trying to achieve. Importantly, physicians should refer patients to a nutrition unit for nutritional therapy as soon as possible after they are diagnosed with diabetes. Highlights of the new guidelines 1. The new guidelines replace the 2008 version of the ADA’s Nutrition Therapy and Recommendations for Diabetes. In addition to the section on diet planning, the new guidelines have some unique recommendations, such as, how to match foods to different types of oral hypoglycemic agents, and basal and mealtime insulin regimens. Given the short time available for clinicians to educate patients about lifestyle interventions, the new guidelines recommend a number of evidence-based “priority topics” for education. These include weight loss and ways to maintain weight loss, and telling patients which foods contain carbohydrates. In terms of carbohydrates, the new guidelines recommend foods that are high in nutritional value and rich in fiber, and urge against the consumption of sugary drinks. 4. The 2008 edition of the guidelines did not recommend a daily calorie allocation ratio of carbohydrate, fat and protein per meal. The new guidelines recommend that nutrient allocation ratios should be based on the individual patient’s current dietary patterns, preferences, and goals. 5. In other areas, the new guidelines recommend replacing foods high in saturated fatty acids with foods containing unsaturated fatty acids, recommend individualized sodium intake recommendations, and advise against the use of specific vitamin or mineral supplements, omega-3 fatty acids, and herbal medicines in patients with diabetes. From the standpoint of the guideline writers, Dr. Evert hopes that the guidelines will encourage physicians and patients to pay more attention to diet and nutritional therapy as one of the key elements of diabetes management. Nutritional therapy should be prioritized, and it is much easier to prescribe nutritional therapy than to talk to patients about their eating behaviors. dr. Evert noted that diet and nutritional therapy have shown to have cost-saving benefits in diabetes management and improved glycemic control, but are underutilized, and that nutritional therapy has more room for growth in the future.