Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Incorporate monitoring of diabetes self-care activities into treatment goals in people with diabetes and serious mental illness. B

All people with diabetes should participate in DSME and DSMS both at diagnosis and as needed thereafter. B

• All people with diabetes should participate in DSME and DSMS both at diagnosis and as needed thereafter. B

• Effective self-management, improved clinical outcomes, health status, and quality-of-life are key outcomes of DSME and DSMS and should be measured and monitored as part of care. C

• DSME/S should be patient-centered, respectful, and responsive to individual patient preferences, needs, and values that should guide clinical decisions. A

DSME/S programs have the necessary elements in their curricula to delay or prevent the development of type 2 diabetes; DSME/S programs should be able to tailor their content when prevention of diabetes is the desired goal. B

• DSME/S programs have the necessary elements in their curricula to delay or prevent the development of type 2 diabetes; DSME/S programs should be able to tailor their content when prevention of diabetes is the desired goal. B

• Because DSME and DSMS can improve outcomes and reduce costs B, DSME and DSMS should be adequately reimbursed by third-party payers. E

Four critical time points for DSME/S delivery:

• Four critical time points for DSME/S delivery:

• At diagnosis

• Annually for assessment of education, nutrition, and emotional needs

• When new complicating factors arise that influence self-management; and

• When transitions in care occur

Promote & support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve health and to:

• Promote & support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve health and to:

• Achieve and maintain body weight goals
• Attain individualized glycemic, blood pressure, and lipid goals
• Delay or prevent complications of diabetes

• Address nutrition needs based on personal & cultural preferences, health literacy & numeracy, access to healthful foods, willingness and ability to make behavioral changes & barriers to change.

Energy Balance:

• Energy Balance:

• Modest weight loss achievable by the combination of lifestyle modification and the reduction of calorie intake benefits overweight or obese adults with type 2 diabetes and also those with prediabetes. Intervention programs to facilitate this process are recommended. A

Eating patterns & macronutrient distribution:

• Eating patterns & macronutrient distribution:

• Macronutrient distribution should be individualized while keeping total calorie and metabolic goals in mind. E

• Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars. B

Eating patterns & macronutrient distribution (2):

• Eating patterns & macronutrient distribution (2):

• People with diabetes and those at risk should avoid sugar-sweetened beverages to control weight and reduce their risk for CVD and fatty liver B and should minimize the consumption of foods with added sugar that have the capacity to displace healthier, more nutrient-dense food choices. A

• A variety of eating patterns are acceptable for the management of type 2 diabetes and prediabetes including Mediterranean, DASH, and plant-based diets. B

Protein:

• Protein:

• In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia. B

Dietary Fat:

• Dietary Fat:

• An eating plan emphasizing elements of a Mediterranean-style diet rich in monounsaturated fats may improve glucose metabolism and lower CVD risk and can be an effective alternative to a low-fat, high-carb diet. B

• Eating foods containing long-chain ω-3 fatty acids, such as fatty fish, nuts, and seeds, is recommended to prevent or treat CVD B; however, evidence does not support a beneficial role for ω-3 dietary supplements. A

Micronutrients and herbal supplements:

• Micronutrients and herbal supplements:

• There is no clear evidence that dietary supplementation with vitamins, minerals, herbs, or spices can improve diabetes, and there may be safety concerns regarding the long-term use of antioxidant supplements such as vitamins E and C and carotene. C