Search

Medical Nutrition Therapy (MNT) plays an important role in the management of Type 2 Diabetes Mellitus. Care providers working with patients suffering this disorder should offer individualized goals of MNT and promote healthy eating patterns. They will be familiar with recommendations of carbohydrates, fats, proteins, micronutrients and alcohol, changes of diet due to physical activity, or oral diabetes medications and insulin therapy. They should define steps for implementation of nutrition recommendations, taking into consideration special situations such as snacking, traveling, eating away from home, holidays and special occasions, managing illnesses that affect food intake and timing.

Type 2 diabetes (T2D) and prediabetes have a major global impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. To mitigate this disease burden, interventions of proven effectiveness must be used. Evidence shows that nutrition therapy improves glycemic control and reduces the risks of diabetes and its complications. Accordingly, diabetes-specific nutrition therapy should be incorporated into comprehensive patient management programs. Evidence-based recommendations for healthy lifestyles that include healthy eating can be found in clinical practice guidelines (CPGs) from professional medical organizations. To enable broad implementation of these guidelines, recommendations must be reconstructed to account for cultural differences in lifestyle, food availability, and genetic factors. To begin, published CPGs and relevant medical literature were reviewed and evidence ratings applied according to established protocols for guidelines. From this information, an algorithm for the nutritional management of people with T2D and prediabetes was created. Subsequently, algorithm nodes were populated with transcultural attributes to guide decisions. The resultant transcultural diabetes-specific nutrition algorithm (tDNA) was simplified and optimized for global implementation and validation according to current standards for CPG development and cultural adaptation. Thus, the tDNA is a tool to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures and geographic locations. It is anticipated that this novel approach can reduce the burden of diabetes, improve quality of life, and save lives. The specific Southeast Asian and Asian Indian tDNA versions can be found in companion articles in this issue of Current Diabetes Reports.

Une enquete retrospective a ete realisee en 1994, incluant 496 patients adultes qui ont debute une nutrition parenterale a domicile (NPAD) au cours de l'annee 1993, au sein de 75 centres repartis dans 13 pays europeens. Pour les pays ayant enregistre plus de 80% des nouveaux cas (423 patients), l'incidence et la prevalence furent estimees dans une echelle de 0,2 a 4,6 patients et de 0,3 a 12,2 patients pour 1 000 000 habitants par an, respectivement. Chez les patients etudies, la maladie sous-jacente etait soit un cancer (42%), une maladie de Crohn (15%), une maladie vasculaire (13%), une enterite radique (8%), un syndrome d'immunodeficience acquise (4%) ou autre (18%), Le syndrome du grele court et l'obstruction intestinale etaient les deux indications majeures pour la NPAD, respectivement dans 31% et 22% des cas. Soixante-trois pour cent des centres avaient une equipe de nutrition. La NPAD etait le plus souvent administree via un catheter central tunnelise (73%) et sous le mode cyclique nocturne (90%), alors qu'elle etait la seule source de nutrition dans 33% des cas. Seulement 44 % de patients prenaient en charge de maniere autonome leur NPAD. La presente etude indique que le cancer est devenu actuellement l'indication majeure pour la NPAD en Europe ; il existe cependant une grande heterogeneite dans les indications parmi les pays europeens ayant participe a l'enquete. La probabilite de survie apres une duree allant de 6 a 12 mois etait faible en cas de SIDA (n = 8; 12%) et de cancer (n = 78; 29%) mais tres satisfaisante dans les autres indications de NPAD (n = 115 ; 92%).