Diabetes: Specific Eating Plans Help

When it comes to diabetes nutrition, patients do best when they get specific instructions on what and how to eat.

When it comes to diabetes nutrition, specific instructions are the way to go.

In the first randomized trial to compare different models of nutrition therapy, researchers found the best results came from highly structured directions.

The Nutrition Pathway Study compared three models of nutrition therapy in 108 adults who were overweight or obese and had uncontrolled type 2 diabetes treated with multiple oral and injected medications other than insulin. They measured glucose levels, body weight, and cardiovascular risk factors to see which model had the best results.

The first group, made up of 36 randomly assigned patients, received traditional counsel. They met with a registered dietitian, reviewed their eating habits and preferences, and then received individualized guidance of developing meal plans to suit their tastes.

A second group was given much less freedom to select their meals. While individuals in this group also met with a registered dietitian, they received highly prescriptive menus based on macronutrient ratios and calorie levels. Not only did they get instructions on specific meal composition and menus, they also got a supply of replacement foods and kept food diaries to track their efforts. A third group had the same structured plan but also received weekly telephone coaching from their dietitians.

That careful adherence to a specific plan paid off. The highly structured plan resulted in the most significant improvements in HbA1c levels, body weight, and lipid profiles, and those who were coached did even better than those who followed the plan on their own. These groups saw an average reduction in HbA1c levels of 0.67 percent and 3.5 kg lost over 16 weeks. On the other hand, the first group, which had traditional counseling, saw no change in HbA1c levels and weight. No participants changed exercise, medications, or other behaviors during the study.

"This drop in A1C due to nutrition therapy alone is much better than what we have been able to achieve with many of the current medications for type 2 diabetes," said Osama Hamdy, MD, PhD, Medical Director of the Obesity Clinical Program at the Joslin Diabetes Center in Boston, and lead investigator. “This is very encouraging since participants in the study have lived with type 2 diabetes for more than 10 years and were not able to control their blood glucose or weight with multiple medications."

He added that Joslin had been using structured plans in their Why WAIT program and that patients found it easier to follow. The findings were presented at the 76th Scientific Sessions of the American Diabetes Association held in New Orleans, La., in June.