Table 1—Continued
Topic Recommendation Evidence rating
NNSs and hypocaloric sweeteners Use of NNSs has the potential to reduce overall calorie and carbohydrate intake if
substituted for caloric sweeteners without compensation by intake of additional
calories from other food sources.
B
Protein For people with diabetes and no evidence of diabetic kidney disease, evidence is
inconclusive to recommend an ideal amount of protein intake for optimizing
glycemic control or improving one or more CVD risk measures; therefore, goals
should be individualized.
C
For people with diabetes and diabetic kidney disease (either micro- or
macroalbuminuria), reducing the amount of dietary protein below usual intake is
not recommended because it does not alter glycemic measures, cardiovascular risk
measures, or the course of GFR decline.
A
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
Total fat Evidence is inconclusive for an ideal amount of total fat intake for people with
diabetes; therefore, goals should be individualized. C Fat quality appears to be far
more important than quantity. B
C, B
MUFAs/PUFAs In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may
benefit glycemic control and CVD risk factors and can therefore be recommended as
an effective alternative to a lower-fat, higher-carbohydrate eating pattern.
B
Omega-3 fatty acids Evidence does not support recommending omega-3 (EPA and DHA) supplements for
people with diabetes for the prevention or treatment of cardiovascular events.
A
As recommended for the general public, an increase in foods containing long-chain
omega-3 fatty acids (EPA and DHA) (fromfatty fish) and omega-3 linolenic acid (ALA)
is recommended for individuals with diabetes because of their beneficial effects on
lipoproteins, prevention of heart disease, and associations with positive health
outcomes in observational studies.
B
The recommendation for the general public to eat fish (particularly fatty fish) at least
two times (two servings) per week is also appropriate for people with diabetes.
B
Saturated fat, dietary cholesterol, and
trans fat
The amount of dietary saturated fat, cholesterol, and trans fat recommended for
people with diabetes is the same as that recommended for the general population.
C
Plant stanols and sterols Individuals with diabetes and dyslipidemia may be able to modestly reduce total and
LDL cholesterol by consuming 1.6–3 g/day of plant stanols or sterols typically found
in enriched foods.
C
Micronutrients and herbal supplements There is no clear evidence of benefit from vitamin or mineral supplementation in
people with diabetes who do not have underlying deficiencies.
C
c Routine supplementation with antioxidants, such as vitamins E and C and
carotene, is not advised because of lack of evidence of efficacy and concern
related to long-term safety.
A
c There is insufficient evidence to support the routine use of micronutrients such as
chromium, magnesium, and vitamin D to improve glycemic control in people with
diabetes.
C
c There is insufficient evidence to support the use of cinnamon or other herbs/
supplements for the treatment of diabetes.
C
It is recommended that individualized meal planning include optimization of food
choices to meet recommended dietary allowance/dietary reference intake for all
micronutrients.
E
Alcohol If adults with diabetes choose to drink alcohol, they should be advised to do so in
moderation (one drink per day or less for adult women and two drinks per day or
less for adult men).
E
Alcohol consumption may place people with diabetes at increased risk for delayed
hypoglycemia, especially if taking insulin or insulin secretagogues. Education and
awareness regarding the recognition and management of delayed hypoglycemia is
warranted.
C
Sodium The recommendation for the general population to reduce sodium to less than 2,300
mg/day is also appropriate for people with diabetes.
B
For individuals with both diabetes and hypertension, further reduction in sodium
intake should be individualized.