Category: Diet

Ac and diet control

Ac and diet control

Ac and diet control preparations, insulin regimens, and timing of dosing are discussed Ax detail elsewhere. Making these changes can help you improve Books and literature collection day-to-day blood sugar management Dontrol lower riet A1C. See 'Microvascular outcomes' below and "Sodium-glucose cotransporter 2 inhibitors for the diiet of hyperglycemia in type 2 diabetes mellitus" and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus". These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. See 'Glycemic management' above and "Glycemic control and vascular complications in type 2 diabetes mellitus", section on 'Choosing a glycemic target'. This is both interesting and causes for caution:. READ MORE.

A1C is a blood Belly fat burning exercises that shows how siet your diabetes management plan is working. Cobtrol some, home contrlo sugar conrtol can be an important and useful tool for controo blood sugar on a day-to-day basis.

For this reason, your doctor may occasionally administer a ajd test contrkl measures your average blood sugar level Energy boosters for busy professionals the dift three months.

Called hemoglobin A1C, dist A1C, this test Af Ac and diet control you Ad well your type 2 diabetes management Acc is working. If your blood sugar levels AAc remained stable and your Conhrol is diiet your target Holistic immune support, the American Znd Association ADA recommends getting the siet two times a year.

If your therapy contorl changed or Holistic immune support contrrol not meeting your blood sugar targets, the ADA diiet getting the test four times per doet. The A1C comtrol results provide insight Ac and diet control how your treatment conttol is duet and how it might be modified A better Curcumin and Diabetes the condition.

Dieh, your blood sample is sent cntrol to die lab, though coontrol doctors can use a point-of-care A1C test, where a finger stick can Weight loss and body image done in the det, with results available in about 10 minutes.

While in-office tests can be contfol to monitor anf disease, dket National Institute contrrol Diabetes and Digestive and Kidney Diseases NIDDK amd Ac and diet control most Dehydration and muscle cramps tests cobtrol not be used for diagnosis.

That can only be done by lab Dehydration and its effects on sports performance certified by the ConrtolAc and diet control organization that standardizes A1C test dieh. Any in-office test xontrol pointing to a cotrol in your cotnrol should be confirmed by Fat intake and obesity lab tests.

As glucose Balancing oily skin the bloodstream, it binds siet hemoglobin. Dodell cotnrol. According to the ADAan A1C level below 5. For cotrol people with type 2 diabetes, the goal is to reduce Contril levels. Cobtrol A1C goal is specific to you.

Several factors come die play, such as your age, how didt the diabetes is, and whether you have vontrol other health Skinfold measurement sites. If you can die your A1C Ac and diet control conrrol your goal — Energy enhancing tips, for many people with diabetes, conrtol less than 7 percent, says Dodell ccontrol you can reduce the risk of complications, Plant-based recipes as nerve Preventing blood sugar spikes and eye problems.

Your A1C score is a Holistic immune support tool, Dodell says, but it is not the only indicator of how healthy you are. For example, you could hit your A1C goal but still have wide fluctuations in your blood sugar levels, which is more common among people who take insulin.

Think of your diabetes as you would a job, Dodell says. It takes work, but the time and effort you put into it can result in good control and an improved quality of life.

Making these changes can help you improve your day-to-day blood sugar management and lower your A1C. Different types of exercise both strength or resistance training and aerobic exercise can lower your A1C by making your body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising and to aim for two days of strength training per week.

Be sure to check with your healthcare provider before embarking on an exercise planthough. Together, you can come up with an individualized plan.

And if you monitor your blood sugar daily, check it before and after exercise. As the ADA explains, exercise improves insulin sensitivity and lowers your blood sugar levels.

In certain circumstances, though, stress hormones produced during more intense exercise can also increase blood sugar levels. In addition, other factors, such as what you anv before exercise and the timing of your workout, may also affect your numbers.

But a great rule of thumb is to fill half of your plate with veggiesa quarter with protein, and a quarter with whole grains, says Turkel. If you like fruitlimit your portion to a small cup, eaten with a little protein or lean fat to help you digest the carbohydrates in a way that is less likely to spike your blood sugar.

Also, avoid processed foods as much as possible, and try to avoid sugary sodas and fruit juice, which are high in carbs and calories, and thus can lead to spikes in blood sugar and contribute to weight gain, according to the ADA.

Skipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much, Cleveland Clinic points out. This is especially true if you are taking insulin or certain other diabetes drugs. Your doctor can help you determine the best meal schedule for your lifestyle.

Diabetes treatment is very individualized, noted a February article in Adn, Metabolic Syndrome and Obesity: Targets and Therapy. Your healthcare team will help you determine which steps to take to successfully manage diabetes. Always talk to your doctor before making any changes, such as starting a diet very low in carbohydrates or beginning a new exercise regimen.

This is especially important before making any medication or insulin changes. Work with your doctor to determine if you should check your blood sugar — and how often. You may be tempted to pick up an A1C home testing kit, but Dodell says having your A1C checked by your doctor every three to six months is sufficient.

A better idea is to use a continuous glucose monitor. For many people that is 70 to milligrams per deciliter 3. Understanding your A1C levels is an important part of your overall diabetes management.

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By Sheryl Huggins Salomon. Medically Reviewed. Kacy Church, MD. How often do you get your A1C tested? Once a year Twice a year Three to four times a year Once every few years I've never had my A1C tested. How Often Do You Need to Take an A1C Test?

What Do Your A1C Results Mean?

: Ac and diet control

How to Lower Your A1C Level

When sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources.

SSB consumption in the general population contributes to a significantly increased risk of type 2 diabetes, weight gain, heart disease, kidney disease, nonalcoholic liver disease, and tooth decay The U.

Food and Drug Administration FDA has reviewed several types of sugar substitutes for safety and approved them for consumption by the general public, including people with diabetes In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners.

These include saccharin, neotame, acesulfame-K, aspartame, sucralose, advantame, stevia, and luo han guo or monk fruit.

Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control. However, an American Heart Association science advisory on the consumption of beverages containing sugar substitutes that was supported by the ADA concluded there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy.

If sugar substitutes are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake , although further research is needed to confirm these concepts Multiple mechanisms have been proposed for potential adverse effects of sugar substitutes, e.

As people aim to reduce their intake of SSBs, the use of other alternatives, with a focus on water, is encouraged Sugar alcohols represent a separate category of sweeteners. Like sugar substitutes, sugar alcohols have been approved by the FDA for consumption by the general public and people with diabetes.

Whereas sugar alcohols have fewer calories per gram than sugars, they are not as sweet. Therefore, a higher amount is required to match the degree of sweetness of sugars, generally bringing the calorie content to a level similar to that of sugars Use of sugar alcohols needs to be balanced with their potential to cause gastrointestinal effects in sensitive individuals.

Currently, there is little research on the potential benefits of sugar alcohols for people with diabetes It is recommended that adults with diabetes or prediabetes who drink alcohol do so in moderation one drink or less per day for adult women and two drinks or less per day for adult men.

Educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended.

The importance of glucose monitoring after drinking alcohol beverages to reduce hypoglycemia risk should be emphasized. It is important that health care providers counsel people with diabetes about alcohol consumption and encourage moderate and sensible use for people choosing to consume alcohol.

One alcohol-containing beverage is defined as oz beer, 5-oz wine, or 1. Starting with one drink per day, risk for reduced adherence to self-care and healthy lifestyle behaviors has been reported with increasing alcohol consumption Despite the potential glycemic and cardiovascular benefits of moderate alcohol consumption, alcohol intake may place people with diabetes at increased risk for delayed hypoglycemia , — This is particularly relevant for those using insulin or insulin secretagogues who can experience delayed nocturnal or fasting hypoglycemia after evening alcohol consumption.

Consuming alcohol with food can minimize the risk of nocturnal hypoglycemia , It is essential that people with diabetes receive education regarding the recognition and management of delayed hypoglycemia and the potential need for more frequent glucose monitoring after consuming alcohol , Comprehensive reviews and meta-analyses suggest a protective effect of moderate alcohol intake on the risk of developing type 2 diabetes, with a higher rate of diabetes in alcohol abstainers and heavy consumers , — Knott et al.

A meta-analysis and systematic review that examined the effects of specific types of alcohol beverage consumption and the incidence of type 2 diabetes found that wine consumption was associated with significantly lower diabetes risk, as compared with a smaller reduction in risk with beer and spirits.

While epidemiologic evidence shows a correlation between alcohol consumption and risk of diabetes, the evidence does not suggest that providers should advise abstainers to start consuming alcohol.

Without underlying deficiency, the benefits of multivitamins or mineral supplements on glycemia for people with diabetes or prediabetes have not been supported by evidence, and therefore routine use is not recommended.

It is recommended that MNT for people taking metformin include an annual assessment of vitamin B12 status with guidance on supplementation options if deficiency is present. The routine use of chromium or vitamin D micronutrient supplements or any herbal supplements, including cinnamon, curcumin, or aloe vera, for improving glycemia in people with diabetes is not supported by evidence and is therefore not recommended.

Scientific evidence does not support the use of dietary supplements in the form of vitamins or minerals to meet glycemic targets or improve CVD risk factors in people with diabetes or prediabetes, in the absence of an underlying deficiency — People with diabetes not achieving glucose targets may have an increased risk of micronutrient deficiencies , so maintaining a balanced intake of food sources that provide at least the recommended daily allowance for nutrients and micronutrients is essential For special populations, including women planning pregnancy, people with celiac disease, older adults, vegetarians, and people following an eating plan that restricts overall calories or one or more macronutrients, a multivitamin supplement may be justified A systematic review on the effect of chromium supplementation on glucose and lipid metabolism concluded that evidence is limited by poor study quality and heterogeneity in methodology and results , Evidence from clinical studies that evaluated magnesium , and vitamin D — supplementation to improve glycemia in people with diabetes is likewise conflicting.

However, evidence is emerging that suggests that magnesium status may be related to diabetes risk in people with prediabetes It is important to consider that nutritional supplements and herbal products are not standardized or regulated , Health care providers should ask about the use of supplements and herbal products, and providers and people with or at risk for diabetes should discuss the potential benefit of these products weighed against the cost and possible adverse effects and drug interactions.

The variability of herbal and micronutrient supplements makes research in this area challenging and makes it difficult to conclude effectiveness. To date, there is limited evidence supporting the addition of herbal supplements to manage glycemia.

Because of public interest and the lack of conclusive data, the National Center for Complementary and Integrative Health at the National Institutes of Health aims to answer important public health and scientific questions by funding and conducting research on complementary medicine.

Metformin is associated with vitamin B12 deficiency, with a recent systematic review recommending that annual blood testing of vitamin B12 levels be considered in metformin-treated people, especially in those with anemia or peripheral neuropathy This study found that even in the absence of anemia, B12 deficiency was prevalent.

The exact cause of B12 deficiency in people taking metformin is not known, but some research points to malabsorption caused by metformin, with other studies suggesting improvements in B12 status with calcium supplementation — The standard of treatment has been B12 injections, but new research suggest that high-dose oral supplementation may be as effective , More research is needed in this area.

All RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan.

For individuals with type 1 diabetes, intensive insulin therapy using the carbohydrate counting approach can result in improved glycemia and is recommended.

For adults using fixed daily insulin doses, consistent carbohydrate intake with respect to time and amount, while considering the insulin action time, can result in improved glycemia and reduce the risk for hypoglycemia. A cautious approach to increasing mealtime insulin doses is suggested; continuous glucose monitoring CGM or self-monitoring of blood glucose SMBG should guide decision-making for administration of additional insulin.

RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan. Along with other diabetes care providers, RDNs who possess advanced practice training and clinical expertise should take an active role in facilitating and maintaining organization-approved diabetes medication protocols.

For people with type 1 diabetes using basal-bolus insulin therapy, a primary focus for MNT should include guidance on adjusting insulin based on anticipated dietary intake, particularly carbohydrate intake 9 , — ; recent or expected physical activity; and glucose data.

Intensive insulin management education programs that include nutrition therapy have been shown to improve A1C 9 , , , — and quality of life 9 , For people using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be consistent with respect to time and amount per meal 9 , , Checking glucose 3 h after eating may help to determine if additional insulin adjustments i.

Because these insulin dosing algorithms require determination of anticipated nutrient intake to calculate the mealtime dose, health literacy and numeracy should be evaluated. The effectiveness of insulin dosing decisions should be confirmed with a structured approach to SMBG or CGM to evaluate individual responses and guide insulin dose adjustments.

In general, replacing saturated fat with unsaturated fats reduces both total cholesterol and LDL-C and also benefits CVD risk.

In type 2 diabetes, counseling people on eating patterns that replace foods high in carbohydrate with foods lower in carbohydrate and higher in fat may improve glycemia, triglycerides, and HDL-C; emphasizing foods higher in unsaturated fat instead of saturated fat may additionally improve LDL-C.

The recommendation for the general public to eat a serving of fish particularly fatty fish at least two times per week is also appropriate for people with diabetes. Nutrition therapy that includes the development of an eating plan designed to optimize blood glucose trends, blood pressure, and lipid profiles is important in the management of diabetes and can lower the risk of CVD, CHD, and stroke 9.

Findings from clinical trials support the role of nutrition therapy for achieving glycemic targets and decreasing various markers of cardiovascular and hypertension risk 9 , 24 , — There has been increasing research examining the effects of high-fat, low-carbohydrate eating patterns on cardiometabolic risk factors, with two systematic reviews showing benefits of low-carbohydrate eating plans compared with low-fat eating plans on glycemic and CVD risk parameters in the treatment of type 2 diabetes see the section Low-Carbohydrate or Very Low-Carbohydrate Eating Patterns , The scientific rationale for decreasing saturated fat in the diet is based on the effect of saturated fat in raising LDL-C, a contributing factor in atherosclerosis In a Presidential Advisory on dietary fat and CVD, the American Heart Association concluded that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD Subgrouping of the studies suggested that benefit occurred by replacing saturated fat with polyunsaturated fat but not with carbohydrate or protein In a systematic review of observational studies, saturated fats were not associated with all-cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but limitations common to observational studies were noted The replacement of saturated fat with monounsaturated or polyunsaturated fat in food or replacement of trans fat with monounsaturated fat in food was inversely associated with CVD In general, replacing saturated fat with unsaturated fats, especially polyunsaturated fat, significantly reduces both total cholesterol and LDL-C, and replacement with monounsaturated fat from plant sources, such as olive oil and nuts, reduces CVD risk.

Replacing saturated fat with carbohydrate also reduces total cholesterol and LDL-C, but significantly increases triglycerides and reduces HDL-C , A recent meta-analysis of nine RCTs showed that, compared with control, the Mediterranean-style eating pattern, which is high in monounsaturated fats from plant sources such as olive oil and nuts, improved outcomes of glycemia, body weight, and cardiovascular risk factors in participants with type 2 diabetes A systematic review and meta-analysis of 24 studies and including 1, participants compared the effect of eating plans high in monounsaturated fat with that of eating plans high in carbohydrates.

The eating plans high in monounsaturated fat showed significant reductions in fasting glucose, triglycerides, body weight, and systolic blood pressure along with significant increases in HDL-C. The systematic review and meta-analysis also reviewed four studies with a total of 44 participants comparing eating plans high in monounsaturated fat with those high in polyunsaturated fat.

The eating plans high in monounsaturated fat led to a significant reduction in fasting plasma glucose As is recommended for the general public, an increase in foods containing the long-chain omega-3 fatty acids EPA and docosahexaenoic acid DHA , such as are found in fatty fish, 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 , For people following a vegetarian or vegan eating pattern, omega-3 α-linoleic acid ALA found in plant foods such as flax, walnuts, and soy are reasonable replacements for foods high in saturated fat and may provide some CVD benefits, though the evidence is inconclusive.

Evidence does not conclusively support recommending omega-3 EPA and DHA supplements for all people with diabetes for the prevention or treatment of cardiovascular events. Omega-3 fatty acid supplements have not reduced CVD events or mortality in randomized trials but may have utility in people who require triglyceride reduction , A meta-analysis of seven RCTs showed that increased trans fat intake did not result in changes in glucose, insulin, or triglyceride concentrations but led to an increase in total and LDL-C and a decrease in HDL-C concentrations Trans fats also have been associated with all-cause mortality, total CHD, and CHD mortality Some studies measuring urine sodium excretion in people with type 1 and type 2 diabetes have shown increased mortality associated with the lowest sodium intakes.

When individualizing sodium intake recommendations, careful consideration must be given to issues such as food preference, palatability, availability, and additional cost of fresh or specialty low-sodium products In individuals with diabetes and non—dialysis-dependent diabetic kidney disease DKD , reducing the amount of dietary protein below the recommended daily allowance 0.

Historically, low-protein eating plans were advised to reduce albuminuria and progression of chronic kidney disease in people with DKD, typically with improvements in albuminuria but no clear effect on estimated glomerular filtration rate.

In addition, there is some indication that a low-protein eating plan may lead to malnutrition in individuals with DKD — The average daily level of protein intake for people with diabetes without kidney disease is typically 1—1.

Evidence does not suggest that people with DKD need to restrict protein intake to less than the average protein intake. For people with DKD and macroalbuminuria, changing to a more soy-based source of protein may improve CVD risk factors but does not appear to alter proteinuria , Correcting hyperglycemia is one strategy for the management of gastroparesis, as acute hyperglycemia delays gastric emptying.

Consultation by an RDN knowledgeable in the management of gastroparesis is helpful in setting and maintaining treatment goals Treatment goals include managing and reducing symptoms; correcting fluid, electrolyte, and nutritional deficiencies and glycemic imbalances; and addressing the precipitating cause s with appropriate drug therapy Correcting hyperglycemia is one strategy for the management of gastroparesis, as acute hyperglycemia delays gastric emptying , Modification of food and beverage intake is the primary management strategy, especially among individuals with mild symptoms.

People with gastroparesis may find it helpful to eat small, frequent meals. Replacing solid food with a greater proportion of liquid calories to meet individualized nutrition requirements may be helpful because consuming solid food in large volumes is associated with longer gastric emptying times , Large meals can also decrease the lower esophageal sphincter pressure, which may cause gastric reflux, providing further aggravation Many of the foods typically recommended for people with diabetes, such as leafy green salads, raw vegetables, beans, and fresh fruits, and other food like fatty or tough meat, can be some of the most difficult foods for the gastroparetic stomach to grind and empty , Notably, the majority of nutrition therapy interventions for gastroparesis are based on the knowledge of the pathophysiology and clinical judgment rather than empirical research The use of an insulin pump is another option for individuals with type 1 diabetes and insulin-requiring type 2 diabetes with gastroparesis A small but positive month trial reported a 1.

An insulin pump can be used to provide consistent basal insulin infusion, as well as the ability to modify mealtime insulin delivery doses as needed. The variable bolus feature allows the user to administer a portion of the meal bolus in an extended fashion over a longer period of time Use of this feature may help to decrease the risk of postprandial hyperglycemia as well as hypoglycemia.

When an individual with gastroparesis falls below target weight, nutrition support in the form of oral for acute exacerbation of symptoms , enteral, or parenteral nutrition should be considered Studies using personalized nutrition approaches to examine genetic, metabolomic, and microbiome variations have not yet identified specific factors that consistently improve outcomes in type 1 diabetes, type 2 diabetes, or prediabetes.

Currently, use of nutrition counseling approaches aimed at personalizing guidance based on genetic, metabolomic, and microbiome information is an area of intense research.

Testing has become available commercially, with direct-to-consumer advertising. Some intriguing research has shown, for example, the wide interpersonal variability in blood glucose response to standardized meals that could be predicted by clinical and microbiome profiles At this point, however, no clear conclusions can be drawn regarding their utility owing to wide variations in the markers used for predicting outcomes, in the populations and nutrients studied, and in the associations found.

Ideally, an eating plan should be developed in collaboration with the person with prediabetes or diabetes and an RDN through participation in diabetes self-management education when the diagnosis of prediabetes or diabetes is made.

Regular follow-up with a diabetes health care provider is also critical to adjust other aspects of the treatment plan as indicated. Unfortunately, national data indicate that most people with diabetes do not receive any nutrition therapy or formal diabetes education 4 , 9 , 16 , providing in-person or technology-enabled diabetes nutrition therapy and education integrated with medical management 9 , 12 , 13 , 15 , 16 , 19 , 22 , — , — ;.

engineering solutions that include two-way communication between the individual and his or her health care team to provide individualized feedback and tailored education based on the analyzed patient-generated health data 38 , , ;. increasing the use of community health workers and peer coaches to provide culturally appropriate, ongoing support and clinically linked care coordination and improve the reach of MNT and DSMES 15 , 19 , 23 , 38 , , Evaluating nutrition evidence is complex given that multiple dietary factors influence glycemic management and CVD risk factors, and the influence of a combination of factors can be substantial.

Based on a review of the evidence, it is clear that knowledge gaps continue to exist and further research on nutrition and eating patterns is needed in individuals with type 1 diabetes, type 2 diabetes, and prediabetes.

Future studies should address. the impact of different eating patterns compared with one another, controlling for supplementary advice such as stress reduction, physical activity, or smoking cessation ;.

the impact of weight loss on other outcomes which eating plans are beneficial only with weight loss, which can show benefit regardless of weight loss ;. how cultural or personal preferences, psychological supports, co-occurring conditions, socioeconomic status, food insecurity, and other factors impact being consistent with an eating plan and its effectiveness;.

the need for increased length and size of studies, to better understand long-term impacts on clinically relevant outcomes;. comparisons of different delivery methods aided by technology e. ongoing cost-effectiveness studies that will further support coverage by third-party payers or bundling services into evolving value-based care and payment models.

The authors acknowledge Mindy Saraco Managing Director, Medical Affairs, ADA for her help with the development of the Consensus Report. The authors acknowledge the invited peer reviewers who provided comments on an earlier draft of this report: Kelli Begay Indian Health Service, Rockville, MD , Guoxun Chen University of Tennessee, Knoxville, TN , Frank Hu Harvard T.

Duality of Interest. The authors disclosed all potential financial conflicts of interest with industry. These disclosures were discussed at the onset of the consensus statement development process. The ADA uses general revenues to fund development of its consensus reports and does not rely on industry support for these purposes.

reports honorarium from the Academy of Nutrition and Dietetics and the ADA outside of the submitted work. reports personal fees from Novo Nordisk, Merck, Amgen, Gilead, BOYDSense, the American Medical Group Association, and Janssen and grants from Sanofi, Pfizer, Merck, and Novo Nordisk outside of the submitted work.

reports personal fees from Sunstar Foundation outside of the submitted work. was previously employed by the ADA. reports grants from the National Institutes of Health and internal University of Michigan grants. reports a consulting relationship with dietdoctor. com, which began after the Consensus Report was submitted to Diabetes Care.

No other potential conflicts of interest relevant to this article were reported. Author Contributions. All authors were responsible for drafting the Consensus Report and revising it critically for important intellectual content. All authors approved the version to be published.

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Volume 42, Issue 5. Previous Article Next Article. Data Sources, Searches, and Study Selection. EATING PATTERNS. MNT and Antihyperglycemic Medications Including Insulin.

Article Information. Article Navigation. Continuing Evolution of Nutritional Therapy for Diabetes April 15 Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report Alison B.

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toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1 Goals of nutrition therapy. View Large. Table 2 Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines—recommended structure for the implementation of MNT for adults with diabetes 9.

Initial series of MNT encounters : The RDN should implement three to six MNT encounters during the first 6 months following diagnosis and determine if additional MNT encounters are needed based on an individualized assessment. MNT follow-up encounters: The RDN should implement a minimum of one annual MNT follow-up encounter.

Table 3 Eating patterns reviewed for this report. Type of eating pattern. USDA Dietary Guidelines For Americans DGA 8 Emphasizes a variety of vegetables from all of the subgroups; fruits, especially whole fruits; grains, at least half of which are whole intact grains; lower-fat dairy; a variety of protein foods; and oils.

This eating pattern limits saturated fats and trans fats, added sugars, and sodium. Some plans include fruit e. Avoids starchy and sugary foods such as pasta, rice, potatoes, bread, and sweets. Often has a goal of 20—50 g of nonfiber carbohydrate per day to induce nutritional ketosis.

May also be reduced in sodium. Avoids grains, dairy, salt, refined fats, and sugar. Table 4 Quick reference conversion of percent calories from carbohydrate shown in grams per day as reported in the research reviewed for this report.

Replace sugar-sweetened beverages SSBs with water as often as possible. Selection of small-particle-size foods may improve symptoms of diabetes-related gastroparesis.

Strategies to improve access, clinical outcomes, and cost effectiveness include the following. reducing barriers to referrals and allowing self-referrals to MNT and DSMES; providing in-person or technology-enabled diabetes nutrition therapy and education integrated with medical management 9 , 12 , 13 , 15 , 16 , 19 , 22 , — , — ; engineering solutions that include two-way communication between the individual and his or her health care team to provide individualized feedback and tailored education based on the analyzed patient-generated health data 38 , , ; increasing the use of community health workers and peer coaches to provide culturally appropriate, ongoing support and clinically linked care coordination and improve the reach of MNT and DSMES 15 , 19 , 23 , 38 , , Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.

Search ADS. Management of hyperglycemia in type 2 diabetes, a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. American Diabetes Association.

Nutrition therapy recommendations for the management of adults with diabetes. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes— Institute of Medicine. Accessed 2 October Department of Health and Human Service; U. Accessed 18 January Academy of Nutrition and Dietetics Nutrition practice guideline for type 1 and type 2 diabetes in adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process.

Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. Legal Information Institute. Academy of Nutrition and Dietetics: Revised Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists Competent, Proficient, and Expert in Diabetes Care.

Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial. The effect of medical nutrition therapy by a registered dietitian nutritionist in patients with prediabetes participating in a randomized controlled clinical research trial.

Imbedding interdisciplinary diabetes group visits into a community-based medical setting. Dietitian-coached management in combination with annual endocrinologist follow up improves global metabolic and cardiovascular health in diabetic participants after 24 months.

Briggs Early. Position of the Academy of Nutrition and Dietetics: the role of medical nutrition therapy and registered dietitian nutritionists in the prevention and treatment of prediabetes and type 2 diabetes. A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes.

Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? A systematic review and meta-analysis. Lynch EB, Liebman R, Ventrelle J, Avery EF, Richardson D. A self-management intervention for African Americans with comorbid diabetes and hypertension: a pilot randomized controlled trial.

Prev Chronic Dis ; Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Effects of the First Line Diabetes Care FiLDCare self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines.

The effectiveness and cost of lifestyle interventions including nutrition education for diabetes prevention: a systematic review and meta-analysis. Academy of Nutrition and Dietetics Evidence Analysis Library. MNT: cost effectiveness, cost-benefit, or economic savings of MNT [Internet].

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The Finnish Diabetes Prevention Study DPS : lifestyle intervention and 3-year results on diet and physical activity. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a year follow-up study.

Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over year follow-up: the Diabetes Prevention Program Outcomes Study.

Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a year follow-up study. Medical nutrition therapy and weight loss questions for the Evidence Analysis Library prevention of type 2 diabetes project: systematic reviews.

This can suggest that the individual is not effectively managing their blood sugar. Many studies have shown that lowering A1C levels can help slow the progression of diabetes and reduce the risk of complications — such as nerve damage and cardiovascular disease — in both type 1 and type 2 diabetes.

When it comes to an A1C target range, there is no one-size-fits-all solution. Many factors, including the type of diabetes and general health, can impact an A1C goal. A person can discuss a suitable target with their diabetes healthcare team.

Many strategies, such as physical activity, diet, and medication, can help manage blood glucose levels and, therefore, also A1C levels.

Exercise and lifestyle tips to help lower A1C levels include :. Everyone, especially people with diabetes, can benefit from a healthful diet that includes plenty of fresh fruit and vegetables and whole foods and is low in sugar, salt, and fat.

Monitoring carbohydrate intake can help a person manage their glucose levels. A healthcare professional will advise each person on their dietary needs, including the number of carbs they should consume. Nutrition plays an essential role in managing blood sugar levels. Following a suitable eating plan can help a person keep their blood sugar and A1C levels in a healthy range.

Creating a meal plan can be a useful tool to help a person manage their blood sugar. A dietitian can also help with recommending an eating plan. For people living with diabetes, some important trends to incorporate into an eating plan include :. Learn more about food to help lower and control blood sugar here.

A1C test results appear as a percentage. A higher A1C level means a greater risk of diabetes and its complications. Physicians may also refer to average glucose, or eAG, when they talk about A1C levels.

People can use a simple calculator to help them convert their results from one measurement to the other. A person with prediabetes has a good chance of reversing their high blood sugar levels and preventing diabetes from developing.

Read about more tips and strategies for managing prediabetes here. A1C level recommendations vary between individuals. People with more advanced diabetes will have higher A1C targets than healthy adults without diabetes.

Factors such as life expectancy, treatment response, and medical history also have an impact. A1C levels are a measure of blood glucose over 3 months. A doctor can use this measurement to monitor and diagnose diabetes.

Strategies to manage blood sugar and A1C can include a varied eating plan, regular exercise, and following a diabetes treatment plan. Having a snack before bed can help some people manage their blood sugar levels overnight, offsetting the dawn phenomenon and the Somogyi effect.

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9 Ways to Lower Your A1C Level

If your blood sugar levels have remained stable and your A1C is within your target range, the American Diabetes Association ADA recommends getting the test two times a year. If your therapy has changed or you are not meeting your blood sugar targets, the ADA recommends getting the test four times per year.

The A1C test results provide insight into how your treatment plan is working and how it might be modified to better control the condition. Often, your blood sample is sent out to a lab, though some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes.

While in-office tests can be used to monitor the disease, the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK notes that most point-of-care tests should not be used for diagnosis.

That can only be done by lab tests certified by the NGSP , an organization that standardizes A1C test results. Any in-office test results pointing to a change in your health should be confirmed by conventional lab tests. As glucose enters the bloodstream, it binds to hemoglobin.

Dodell says. According to the ADA , an A1C level below 5. For many people with type 2 diabetes, the goal is to reduce A1C levels. Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and whether you have any other health conditions.

If you can keep your A1C number below your goal — which, for many people with diabetes, is less than 7 percent, says Dodell — you can reduce the risk of complications, such as nerve damage and eye problems. Your A1C score is a helpful tool, Dodell says, but it is not the only indicator of how healthy you are.

For example, you could hit your A1C goal but still have wide fluctuations in your blood sugar levels, which is more common among people who take insulin. Think of your diabetes as you would a job, Dodell says.

It takes work, but the time and effort you put into it can result in good control and an improved quality of life. Making these changes can help you improve your day-to-day blood sugar management and lower your A1C. Different types of exercise both strength or resistance training and aerobic exercise can lower your A1C by making your body more sensitive to insulin, Turkel says.

She encourages her patients not to go more than two days in a row without exercising and to aim for two days of strength training per week. If your BMI is greater than 30 and you are concerned about your risks for developing prediabetes or diabetes, talk to your primary care provider about our Healthy Weight Program.

Join hundreds of others receiving a monthly round-up of our top Lowcountry health and wellness articles. Home Blog How to Lower A1C Naturally. Why a Healthy A1C Matters An A1C test is a simple blood test that measures your average blood glucose sugar levels for the past three months.

According to the American Diabetes Association : A healthy A1C is less than 5. An A1C between 5. An A1C level of 6. Here are three tips for how to lower A1C naturally: Eat a balanced diet. Load up on fresh fruits and vegetables, which are rich in fiber.

Soluble fiber — the type found in beans, nuts, seeds and certain fruits — has been found to be particularly helpful in lowering A1C levels. Eat fewer starchy vegetables, such as potatoes, corn and squash, as these have more carbohydrates and a bigger effect on your blood sugar than non-starchy vegetables.

Limit simple carbohydrates, such as refined grains and sugar. within individualized treatment goals is recommended for all adults with diabetes and prediabetes.

Research provides clarity on many food choices and eating patterns that can help people achieve health goals and quality of life.

The American Diabetes Association ADA emphasizes that medical nutrition therapy MNT is fundamental in the overall diabetes management plan, and the need for MNT should be reassessed frequently by health care providers in collaboration with people with diabetes across the life span, with special attention during times of changing health status and life stages 1 — 3.

This Consensus Report now includes information on prediabetes, and previous ADA nutrition position statements, the last of which was published in 4 , did not.

Nutrition therapy for children with diabetes or women with gestational diabetes mellitus is not addressed in this review but is covered in other ADA publications, specifically Standards of Medical Care in Diabetes 5 , 6.

The authors of this report were chosen following a national call for experts to ensure diversity of the members both in professional interest and cultural background, including a person living with diabetes who served as a patient advocate. An outside market research company was used to conduct the literature search and was paid using ADA funds.

The authors convened in person for one group meeting and actively participated in monthly teleconference calls between February and November Focused teleconference calls, email, and web-based collaboration were also used to reach consensus on final recommendations between November and January The position statement 4 was used as a starting point, and a search was conducted on PubMed for studies published in English between 1 January and 28 February to provide the updated evidence of nutrition therapy interventions in nonhospitalized adults with prediabetes and type 1 and type 2 diabetes.

Details on the keywords and the search strategy are reported in the Supplementary Data , emphasizing randomized controlled trials RCTs , systematic reviews, and meta-analyses of RCTs.

An exception was made to the inclusion criteria for the use of meal studies for the insulin dosing section.

In addition to the search results, in select cases the authors identified relevant research to include in reaching consensus.

The consensus report was peer reviewed see acknowledgments and suggestions incorporated as deemed appropriate by the authors. Though evidence-based, the recommendations presented are the informed, expert opinions of the authors after consensus was reached through presentation and discussion of the evidence.

Refer adults living with type 1 or type 2 diabetes to individualized, diabetes-focused MNT at diagnosis and as needed throughout the life span and during times of changing health status to achieve treatment goals.

Coordinate and align the MNT plan with the overall management strategy, including use of medications, physical activity, etc. Refer adults with diabetes to comprehensive diabetes self-management education and support DSMES services according to national standards. Diabetes MNT is a covered Medicare benefit and should be adequately reimbursed by insurance and other payers or bundled in evolving value-based care and payment models.

DPP-modeled intensive lifestyle interventions and individualized MNT for prediabetes should be covered by third-party payers or bundled in evolving value-based care and payment models. The National Academy of Medicine formerly the Institute of Medicine broadly defines nutrition therapy as the treatment of a disease or condition through the modification of nutrient or whole-food intake 7.

To complement diabetes nutrition therapy, members of the health care team can and should provide evidence-based guidance that allows people with diabetes to make healthy food choices that meet their individual needs and optimize their overall health.

The Dietary Guidelines for Americans DGA — provide a basis for healthy eating for all Americans and recommend that people consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level 8.

For people with diabetes, recommendations that differ from the DGA are highlighted in this report. MNT is an evidence-based application of the nutrition care process provided by an RDN and is the legal definition of nutrition counseling by an RDN in the U.

Essential components of MNT are assessment, nutrition diagnosis, interventions e. The goals of nutrition therapy are described in Table 1. The unique academic preparation, training, skills, and expertise make the RDN the preferred member of the health care team to provide diabetes MNT and leadership in interprofessional team-based nutrition and diabetes care 1 , 9 , 13 — Although certification such as Certified Diabetes Educator, Board Certified-Advanced Diabetes Management is not required, ideally the RDN will have comprehensive knowledge and experience in diabetes care and prevention 9 , Detailed guidance for the RDN to obtain the expert knowledge and experience can be found in the Academy of Nutrition and Dietetics Standards of Practice and Standards of Professional Performance Health care professionals can use the education algorithm suggested by ADA, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics 1 that defines and describes the four critical times to assess, provide, and adjust care.

The algorithm is intended for use by the RDN and the interprofessional team for determining how and when to deliver diabetes education and nutrition services. The number of encounters the person with diabetes might have with the RDN is described in Table 2 9.

Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines—recommended structure for the implementation of MNT for adults with diabetes 9.

In addition to diabetes MNT, DSMES is important for people with diabetes to improve cardiometabolic and microvascular outcomes in a disease that is largely self-managed 1 , 19 — DSMES includes the ongoing process that facilitates the knowledge, skills, and abilities necessary for diabetes self-care throughout the life span, with nutrition as one of the core curriculum topics taught in comprehensive programs Reported hemoglobin A 1c A1C reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes 9.

Strong evidence supports the effectiveness of MNT interventions provided by RDNs for improving A1C, with absolute decreases up to 2. Ongoing MNT support is helpful in maintaining glycemic improvements 9. Cost-effectiveness of lifestyle interventions and MNT for the prevention and management of diabetes has been documented in multiple studies 12 , 17 , 24 , The National Academy of Medicine recommends individualized MNT, provided by an RDN upon physician referral, as part of the multidisciplinary approach to diabetes care 7.

Diabetes MNT is a covered Medicare benefit and should also be adequately reimbursed by insurance and other payers, or bundled in evolving value-based care and payment models, because it can result in improved outcomes such as reduced A1C and cost savings 12 , 17 , The strongest evidence for type 2 diabetes prevention comes from several studies, including the DPP 26 — Diabetes Prevention Program Outcomes Study DPPOS.

The follow-up of the Da Qing study also demonstrated a reduction in cardiovascular and all-cause mortality More intensive intervention programs are the most effective in decreasing diabetes incidence and improving cardiovascular disease CVD risk factors Both DPP-modeled intensive lifestyle interventions and individualized MNT for prediabetes have demonstrated cost-effectiveness 17 , 36 and therefore should be covered by third-party payers or bundled in evolving value-based care and payment models To make diabetes prevention programs more accessible, digital health tools are an area of increasing interest in the public and private sectors.

Preliminary research studies support that the delivery of diabetes prevention lifestyle interventions through technology-enabled platforms and digital health tools can result in weight loss, improved glycemia, and reduced risk for diabetes and CVD, although more rigorous studies are needed 37 — Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with or at risk for diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

When counseling people with diabetes, a key strategy to achieve glycemic targets should include an assessment of current dietary intake followed by individualized guidance on self-monitoring carbohydrate intake to optimize meal timing and food choices and to guide medication and physical activity recommendations.

People with diabetes and those at risk for diabetes are encouraged to consume at least the amount of dietary fiber recommended for the general public; increasing fiber intake, preferably through food vegetables, pulses [beans, peas, and lentils], fruits, and whole intact grains or through dietary supplement, may help in modestly lowering A1C.

Although numerous studies have attempted to identify the optimal mix of macronutrients for the eating plans of people with diabetes, a systematic review 45 found that there is no ideal mix that applies broadly and that macronutrient proportions should be individualized.

Regardless of the macronutrient mix, total energy intake should be appropriate to attain weight management goals. Further, individualization of the macronutrient composition will depend on the status of the individual, including metabolic goals glycemia, lipid profile, etc.

USDA, U. Department of Agriculture. Carbohydrate is a readily used source of energy and the primary dietary influence on postprandial blood glucose 8 , Foods containing carbohydrate—with various proportions of sugars, starches, and fiber—have a wide range of effects on the glycemic response. Some result in an extended rise and slow fall of blood glucose concentrations, while others result in a rapid rise followed by a rapid fall The quality of carbohydrate foods selected—ideally rich in dietary fiber, vitamins, and minerals and low in added sugars, fats, and sodium— should be addressed as part of an individualized eating plan that includes all components necessary for optimal nutrition 4 , 9.

The amount of carbohydrate intake required for optimal health in humans is unknown. The regular intake of sufficient dietary fiber is associated with lower all-cause mortality in people with diabetes 51 , Therefore, people with diabetes should consume at least the amount of fiber recommended by the DGA — minimum of 14 g of fiber per 1, kcal with at least half of grain consumption being whole intact grains 8.

Other sources of dietary fiber include nonstarchy vegetables, avocados, fruits, and berries, as well as pulses such as beans, peas, and lentils. However, such very high intake of fiber may cause flatulence, bloating, and diarrhea. Meeting the recommended fiber intake through foods that are naturally high in dietary fiber, as compared with supplementation, is encouraged for the additional benefits of coexisting micronutrients and phytochemicals The use of the glycemic index GI and glycemic load GL to rank carbohydrate foods according to their effects on glycemia continues to be of interest for people with diabetes and those at risk for diabetes.

As defined by Brand-Miller et al. It predicts the peak or near peak response, the maximum glucose fluctuation, and other attributes of the response curve. Further, studies have used varying definitions of low and high GI foods, leading to uncertainty in the utility of GI and GL in clinical care There is limited research in people with diabetes or prediabetes without kidney disease on the impact of various amounts of protein consumed.

Some comparisons of protein amounts have not demonstrated differences in diabetes-related outcomes 57 — Eating patterns that replace certain carbohydrate foods with those higher in total fat, however, have demonstrated greater improvements in glycemia and certain CVD risk factors serum HDL cholesterol [HDL-C] and triglycerides compared with lower fat diets.

The types or quality of fats in the eating plans may influence CVD outcomes beyond the total amount of fat Foods containing synthetic sources of trans fats should be minimized to the greatest extent possible 8.

Ruminant trans fats, occurring naturally in meat and dairy products, do not need to be eliminated because they are present in such small quantities The body makes enough cholesterol for physiological and structural functions such that people do not need to obtain cholesterol through foods.

Although the DGA concluded that available evidence does not support the recommendation to limit dietary cholesterol for the general population, exact recommendations for dietary cholesterol for other populations, such as people with diabetes, are not as clear 8.

Whereas cholesterol intake has correlated with serum cholesterol levels, it has not correlated well with CVD events 65 , More research is needed regarding the relationship among dietary cholesterol, blood cholesterol, and CVD events in people with diabetes.

Large epidemiologic studies have found that consumption of polyunsaturated fat or biomarkers of polyunsaturated fatty acids are associated with lower risk of type 2 diabetes Supplementation with omega-3 fatty acids in prediabetes has demonstrated some efficacy in surrogate outcomes beyond serum triglyceride levels.

The intervention in the PREvención con DIeta MEDiterránea PREDIMED study, comparing a Mediterranean-style eating pattern supplemented either with extra-virgin olive oil or with nuts versus a control diet, reduced incidence of type 2 diabetes among people without diabetes at high cardiovascular risk at baseline The Malmö Diet and Cancer cohort study examined specific food sources of saturated fat and found that intake of saturated fat from dairy products, coconut oil, and palm kernel oil were associated with lower diabetes risk 70 , whereas saturated fat intake was associated with higher risk of diabetes in the PREDIMED study Other meta-analyses of observational studies have not shown an inverse relationship with full-fat dairy intake and diabetes risk 72 , The inconsistent results in the above studies may be due to variations in food sources of fat 70 or the fact that some analyses have relied on self-reported dietary information, which can be limited by inaccuracy.

For more information on fat intake and CVD risk, see the section role of nutrition therapy in the prevention and management of diabetes complications cvd, diabetic kidney disease, and gastroparesis.

A variety of eating patterns combinations of different foods or food groups are acceptable for the management of diabetes. Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:.

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences. For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

An eating pattern represents the totality of all foods and beverages consumed 8 Table 3. Overall, few long-term 2 years or longer randomized trials have been conducted of any of the dietary patterns in any of the conditions examined. The most robust research available related to eating patterns for prediabetes or type 2 diabetes prevention are Mediterranean-style, low-fat, or low-carbohydrate eating plans 26 , 69 , 74 , Epidemiologic studies correlate Mediterranean-style 76 , vegetarian 77 — 80 , and Dietary Approaches to Stop Hypertension DASH 76 , 81 eating patterns with a lower risk of developing type 2 diabetes, with no effect for low-carbohydrate eating patterns Several large type 2 diabetes prevention RCTs 26 , 74 , 83 , 84 used low-fat eating plans to achieve weight loss and improve glucose tolerance, and some demonstrated decreased incidence of diabetes 26 , 74 , Given the limited evidence, it is unclear which of the eating patterns are optimal.

The Mediterranean-style pattern has demonstrated a mixed effect on A1C, weight, and lipids in a number of RCTs 85 — A1C was lowest in the low-carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group One of the largest and longest RCTs, the PREDIMED trial, compared a Mediterranean-style eating pattern with a low-fat eating pattern.

After 4 years, glycemic management improved and the need for glucose-lowering medications was lower in the Mediterranean eating pattern group In addition, the PREDIMED trial showed that a Mediterranean-style eating pattern intervention enriched with olive oil or nuts significantly reduced CVD incidence in both people with and without diabetes Studies of vegetarian or vegan eating plans ranged in duration from 12 to 74 weeks and showed mixed results on glycemia and CVD risk factors.

These eating plans often resulted in weight loss 92 — Two meta-analyses of controlled trials 98 , 99 concluded that vegetarian and vegan eating plans can reduce A1C by an average of 0. In the Look AHEAD Action for Health in Diabetes trial , individuals following a calorie-restricted low-fat eating pattern, in the context of a structured weight loss program using meal replacements, achieved moderate success compared with the control condition eating plan However, lowering total fat intake did not consistently improve glycemia or CVD risk factors in people with type 2 diabetes based on a systematic review 45 , several studies — , and a meta-analysis Benefit from a low-fat eating pattern appears to be mostly related to weight loss as opposed to the eating pattern itself , The Ornish and Pritikin lifestyle programs are two of the best known multicomponent very low-fat eating patterns.

Three nonrandomized single-arm studies with 69 to participants lasting between 3 weeks and 2—3 years show that these multicomponent lifestyle intervention programs may improve glucose levels, weight, blood pressure, and HDL-C, with a mixed effect on triglycerides — Low-carbohydrate eating patterns, especially very low-carbohydrate VLC eating patterns, have been shown to reduce A1C and the need for antihyperglycemic medications.

These eating patterns are among the most studied eating patterns for type 2 diabetes. In trials up to 6 months long, the low-carbohydrate eating pattern improved A1C more, and in trials of varying lengths, lowered triglycerides, raised HDL-C, lowered blood pressure, and resulted in greater reductions in diabetes medication Finally, in another meta-analysis comparing low-carbohydrate to high-carbohydrate eating patterns, the larger the carbohydrate restriction, the greater the reduction in A1C, though A1C was similar at durations of 1 year and longer for both eating patterns Table 4 provides a quick reference conversion of percentage of calories from carbohydrate to grams of carbohydrate based on number of calories consumed per day.

Quick reference conversion of percent calories from carbohydrate shown in grams per day as reported in the research reviewed for this report. Because of theoretical concerns regarding use of VLC eating plans in people with chronic kidney disease, disordered eating patterns, and women who are pregnant, further research is needed before recommendations can be made for these subgroups.

Adopting a VLC eating plan can cause diuresis and swiftly reduce blood glucose; therefore, consultation with a knowledgeable practitioner at the onset is necessary to prevent dehydration and reduce insulin and hypoglycemic medications to prevent hypoglycemia.

No randomized trials were found in people with type 2 diabetes that varied the saturated fat content of the low- or very low-carbohydrate eating patterns to examine effects on glycemia, CVD risk factors, or clinical events.

Most of the trials using a carbohydrate-restricted eating pattern did not restrict saturated fat; from the current evidence, this eating pattern does not appear to increase overall cardiovascular risk, but long-term studies with clinical event outcomes are needed — One small, 8-week study comparing the DASH eating pattern with a control group in people with type 2 diabetes indicated improved A1C, blood pressure, and cholesterol levels and weight loss with the DASH eating pattern, with no difference in triglycerides Another RCT compared the DASH eating pattern incorporating increased physical activity with a standard eating pattern without increased physical activity and found blood pressure was lower in the DASH and physical activity group, but A1C, weight, and lipids did not differ Research studies focused on a paleo eating pattern in adults with type 2 diabetes are small and few, ranging from 13—29 participants, lasting no longer than 3 months, and finding mixed effects on A1C, weight, and lipids — While intermittent fasting is not an eating pattern by definition, it has been included in this discussion because of increased interest from the diabetes community.

Fasting means to go without food, drink, or both for a period of time. People fast for reasons ranging from weight management to upcoming medical visits to religious and spiritual practice.

Intermittent fasting is a way of eating that focuses more on when you eat i. While it usually involves set times for eating and set times for fasting, people can approach intermittent fasting in many different ways. Published intermittent fasting studies involving diabetes and diabetes prevention demonstrate a variety of approaches, including restricting food intake for 18 to 20 h per day, alternate-day fasting, and severe calorie restriction for up to 8 consecutive days or longer Three of the studies — demonstrated that intermittent fasting, either in consecutive days of restriction or by fasting 16 h per day or more, may result in weight loss; however, there was no improvement in A1C compared with a nonfasting eating plan.

One of the studies showed similar reductions in A1C, weight, and medication doses when 2 days of severe energy restriction were compared with chronic energy restriction. Another study looked at men with prediabetes and timing of food intake over a h period, with the intervention group restricted to a 6-h schedule of eating with final meal before 3 p.

compared with a control schedule where eating occurred over a h period; improved insulin sensitivity, β-cell responsiveness, blood pressure, oxidative stress, and appetite were shown in the intervention group The safety of intermittent fasting in people with special health situations, including pregnancy and disordered eating, has not been studied.

For adults with type 1 diabetes, no trials met the inclusion criteria for this Consensus Report related to Mediterranean-style, vegetarian or vegan, low-fat, low-carbohydrate, DASH, paleo, Ornish, or Pritikin eating patterns. A few studies have examined the impact of a VLC eating pattern for adults with type 1 diabetes.

One randomized crossover trial with 10 participants examined a VLC eating pattern aiming for 47 g carbohydrate per day without a focus on calorie restriction compared with a higher carbohydrate eating pattern aiming for g carbohydrate per day for 1 week each. Participants following the VLC eating pattern had less glycemic variability, spent more time in euglycemia and less time in hypoglycemia, and required less insulin A single-arm person trial of a VLC eating pattern aimed at a goal of 75 g of carbohydrate or less per day found that weight, A1C, and triglycerides were reduced and HDL-C increased after 3 months, and after 4 years A1C was still lower and HDL-C was still higher than at baseline This evidence suggests that a VLC eating pattern may have potential benefits for adults with type 1 diabetes, but clinical trials of sufficient size and duration are needed to confirm prior findings.

Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns: 1 emphasize nonstarchy vegetables, 2 minimize added sugars and refined grains, and 3 choose whole foods over highly processed foods to the extent possible Multiple trials and meta-analyses have been published addressing the comparative effects of specific eating patterns for diabetes.

Whereas no single eating pattern has emerged as being clearly superior to all others for all diabetes-related outcomes, evidence suggests certain eating patterns are better for specific outcomes.

All eating patterns include a range of more-healthy versus less-healthy options: lentils and sugar-sweetened beverages are both considered part of a vegan eating pattern; fish and processed red meats are both considered part of a low-carbohydrate eating pattern; and removing the bun from a fast food burger might make it part of a paleo eating pattern but does not necessarily make it healthier.

For adults with type 2 diabetes who are not taking insulin and who have limited health literacy or numeracy, or who are older and prone to hypoglycemia, a simple and effective approach to glycemia and weight management emphasizing appropriate portion sizes and healthy eating may be considered.

People with prediabetes at a healthy weight should be considered for lifestyle intervention involving both aerobic and resistance exercise and a healthy eating plan such as a Mediterranean-style eating plan.

People with diabetes and prediabetes should be screened and evaluated during DSMES and MNT encounters for disordered eating, and nutrition therapy should accommodate these disorders. There is substantial evidence indicating that weight loss is highly effective in preventing progression from prediabetes to type 2 diabetes and in managing cardiometabolic health in type 2 diabetes.

Overweight and obesity are also increasingly prevalent in people with type 1 diabetes and present clinical challenges regarding diabetes treatment and CVD risk factors , Regular physical activity, which can contribute to both weight loss and prevention of weight regain, and behavioral strategies are also important components of lifestyle therapy for weight management 26 , 74 , 83 , — Structured weight loss programs with regular visits and use of meal replacements have been shown to enhance weight loss in people with diabetes — The combined data do not point to a threshold of weight loss for maximal clinical benefits in people with diabetes; rather, the greater the weight loss, the greater the benefits.

The UK Prospective Diabetes Study UKPDS demonstrated that decreases in fasting glucose were correlated with degree of weight loss A meta-analysis conducted by Franz et al. Other meta-analyses focusing on nonmedicine or medicine-assisted weight loss interventions in type 2 diabetes support this finding — More recently, the Look AHEAD trial , compared standard DSMES to a more intensive lifestyle intervention and reduced-calorie eating plan.

The intensive lifestyle intervention resulted in 8. A systematic review of the effectiveness of MNT revealed mixed weight loss outcomes in participants with type 1 and 2 diabetes 9.

Similarly, while DSMES is a fundamental component of diabetes care 1 , it does not consistently produce sufficient weight loss to achieve optimal therapeutic benefits in people with diabetes , , For these reasons, diabetes MNT and DSMES should emphasize a targeted and concerted plan for weight management.

The addition of metabolic surgery , weight loss medications , and glucose-lowering agents that promote weight loss can also be used as an adjunct to lifestyle interventions, resulting in greater weight loss that is maintained for a longer period of time.

The data also support the position that weight loss therapy is effective at all phases of type 2 diabetes, both in individuals with recent-onset disease 1 , and in people with longer durations of diabetes treated with multiple diabetes medications , Regular physical activity by itself , or as part of a comprehensive lifestyle plan 26 , 74 , 83 , can prevent progression to type 2 diabetes in high-risk individuals.

Studies have demonstrated beneficial effects of both aerobic and resistance exercise and additive benefits when both forms of exercise are combined — For purposes of weight loss, the ability to sustain and maintain an eating plan that results in an energy deficit, irrespective of macronutrient composition or eating pattern, is critical for success — Studies investigating specific weight loss eating plans using a broad range of macronutrient composition in people with diabetes have shown mixed results regarding effects on weight, A1C, serum lipids, and blood pressure , , , — As a result, the evidence does not identify one eating plan that is clearly superior to others and that can be generally recommended for weight loss for people with diabetes Individualized eating plans should support calorie reduction e.

Weight loss interventions can be implemented in usual care settings and alternately in telehealth programs , In general, the intervention intensity and degree of individual participation in the program are important factors for successful weight loss — , The Look AHEAD trial and the Diabetes Remission Clinical Trial DiRECT highlight the potential for type 2 diabetes remission—defined as the maintenance of euglycemia complete remission or prediabetes level of glycemia partial remission with no diabetes medication for at least 1 year , —in people undergoing weight loss treatment.

In the Look AHEAD trial, when compared with the control group, the intensive lifestyle arm resulted in at least partial diabetes remission in Diet composition may also play a role; in an RCT by Esposito et al. Obesity prevalence among people with type 1 diabetes has been significantly increasing — A recent study suggested obesity may promote progression to overt type 1 diabetes in at-risk individuals , but further confirmatory studies are needed.

In addition, in people with established type 1 diabetes, presence of obesity can worsen insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors — Therefore, weight management has been recommended as an essential component of care for people with type 1 diabetes who have overweight or obesity — There is a scarcity of evidence from RCTs evaluating weight loss interventions in type 1 diabetes.

A retrospective nested-control study indicated that lifestyle-induced weight loss improved glycemia with a reduction in insulin doses compared with controls Individuals with type 1 diabetes and obesity may benefit from eating plans that result in an energy deficit and that are lower in total carbohydrate and GI and higher in fiber and lean protein Currently, adjunctive pharmacotherapy is not indicated for individuals with type 1 diabetes.

However, there is preliminary evidence that in select individuals with type 1 diabetes and excess adiposity, newer pharmacotherapy i. In addition, metabolic surgery in appropriate candidates can decrease body weight and improve glycemia , When counseling individuals with diabetes and prediabetes about weight management, special attention also must be given to prevent, diagnose, and treat disordered eating.

Disordered eating can make following an eating plan challenging Health care professionals should consider screening for disordered eating, refer to a mental health professional, and individualize nutrition therapy accordingly When sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources.

SSB consumption in the general population contributes to a significantly increased risk of type 2 diabetes, weight gain, heart disease, kidney disease, nonalcoholic liver disease, and tooth decay The U.

Food and Drug Administration FDA has reviewed several types of sugar substitutes for safety and approved them for consumption by the general public, including people with diabetes In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners.

These include saccharin, neotame, acesulfame-K, aspartame, sucralose, advantame, stevia, and luo han guo or monk fruit. Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories.

These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control. However, an American Heart Association science advisory on the consumption of beverages containing sugar substitutes that was supported by the ADA concluded there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy.

If sugar substitutes are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake , although further research is needed to confirm these concepts Multiple mechanisms have been proposed for potential adverse effects of sugar substitutes, e.

As people aim to reduce their intake of SSBs, the use of other alternatives, with a focus on water, is encouraged Sugar alcohols represent a separate category of sweeteners. Like sugar substitutes, sugar alcohols have been approved by the FDA for consumption by the general public and people with diabetes.

Whereas sugar alcohols have fewer calories per gram than sugars, they are not as sweet. Therefore, a higher amount is required to match the degree of sweetness of sugars, generally bringing the calorie content to a level similar to that of sugars Use of sugar alcohols needs to be balanced with their potential to cause gastrointestinal effects in sensitive individuals.

Currently, there is little research on the potential benefits of sugar alcohols for people with diabetes It is recommended that adults with diabetes or prediabetes who drink alcohol do so in moderation one drink or less per day for adult women and two drinks or less per day for adult men.

Educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended. The importance of glucose monitoring after drinking alcohol beverages to reduce hypoglycemia risk should be emphasized.

It is important that health care providers counsel people with diabetes about alcohol consumption and encourage moderate and sensible use for people choosing to consume alcohol. One alcohol-containing beverage is defined as oz beer, 5-oz wine, or 1. Starting with one drink per day, risk for reduced adherence to self-care and healthy lifestyle behaviors has been reported with increasing alcohol consumption Despite the potential glycemic and cardiovascular benefits of moderate alcohol consumption, alcohol intake may place people with diabetes at increased risk for delayed hypoglycemia , — This is particularly relevant for those using insulin or insulin secretagogues who can experience delayed nocturnal or fasting hypoglycemia after evening alcohol consumption.

Consuming alcohol with food can minimize the risk of nocturnal hypoglycemia , It is essential that people with diabetes receive education regarding the recognition and management of delayed hypoglycemia and the potential need for more frequent glucose monitoring after consuming alcohol , Comprehensive reviews and meta-analyses suggest a protective effect of moderate alcohol intake on the risk of developing type 2 diabetes, with a higher rate of diabetes in alcohol abstainers and heavy consumers , — Knott et al.

A meta-analysis and systematic review that examined the effects of specific types of alcohol beverage consumption and the incidence of type 2 diabetes found that wine consumption was associated with significantly lower diabetes risk, as compared with a smaller reduction in risk with beer and spirits.

While epidemiologic evidence shows a correlation between alcohol consumption and risk of diabetes, the evidence does not suggest that providers should advise abstainers to start consuming alcohol.

Without underlying deficiency, the benefits of multivitamins or mineral supplements on glycemia for people with diabetes or prediabetes have not been supported by evidence, and therefore routine use is not recommended.

It is recommended that MNT for people taking metformin include an annual assessment of vitamin B12 status with guidance on supplementation options if deficiency is present.

The routine use of chromium or vitamin D micronutrient supplements or any herbal supplements, including cinnamon, curcumin, or aloe vera, for improving glycemia in people with diabetes is not supported by evidence and is therefore not recommended.

Scientific evidence does not support the use of dietary supplements in the form of vitamins or minerals to meet glycemic targets or improve CVD risk factors in people with diabetes or prediabetes, in the absence of an underlying deficiency — People with diabetes not achieving glucose targets may have an increased risk of micronutrient deficiencies , so maintaining a balanced intake of food sources that provide at least the recommended daily allowance for nutrients and micronutrients is essential For special populations, including women planning pregnancy, people with celiac disease, older adults, vegetarians, and people following an eating plan that restricts overall calories or one or more macronutrients, a multivitamin supplement may be justified A systematic review on the effect of chromium supplementation on glucose and lipid metabolism concluded that evidence is limited by poor study quality and heterogeneity in methodology and results , Evidence from clinical studies that evaluated magnesium , and vitamin D — supplementation to improve glycemia in people with diabetes is likewise conflicting.

However, evidence is emerging that suggests that magnesium status may be related to diabetes risk in people with prediabetes It is important to consider that nutritional supplements and herbal products are not standardized or regulated , Health care providers should ask about the use of supplements and herbal products, and providers and people with or at risk for diabetes should discuss the potential benefit of these products weighed against the cost and possible adverse effects and drug interactions.

The variability of herbal and micronutrient supplements makes research in this area challenging and makes it difficult to conclude effectiveness. To date, there is limited evidence supporting the addition of herbal supplements to manage glycemia.

Because of public interest and the lack of conclusive data, the National Center for Complementary and Integrative Health at the National Institutes of Health aims to answer important public health and scientific questions by funding and conducting research on complementary medicine.

Metformin is associated with vitamin B12 deficiency, with a recent systematic review recommending that annual blood testing of vitamin B12 levels be considered in metformin-treated people, especially in those with anemia or peripheral neuropathy This study found that even in the absence of anemia, B12 deficiency was prevalent.

The exact cause of B12 deficiency in people taking metformin is not known, but some research points to malabsorption caused by metformin, with other studies suggesting improvements in B12 status with calcium supplementation — The standard of treatment has been B12 injections, but new research suggest that high-dose oral supplementation may be as effective , More research is needed in this area.

All RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan. For individuals with type 1 diabetes, intensive insulin therapy using the carbohydrate counting approach can result in improved glycemia and is recommended.

For adults using fixed daily insulin doses, consistent carbohydrate intake with respect to time and amount, while considering the insulin action time, can result in improved glycemia and reduce the risk for hypoglycemia.

A cautious approach to increasing mealtime insulin doses is suggested; continuous glucose monitoring CGM or self-monitoring of blood glucose SMBG should guide decision-making for administration of additional insulin. RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan.

Along with other diabetes care providers, RDNs who possess advanced practice training and clinical expertise should take an active role in facilitating and maintaining organization-approved diabetes medication protocols.

For people with type 1 diabetes using basal-bolus insulin therapy, a primary focus for MNT should include guidance on adjusting insulin based on anticipated dietary intake, particularly carbohydrate intake 9 , — ; recent or expected physical activity; and glucose data.

Intensive insulin management education programs that include nutrition therapy have been shown to improve A1C 9 , , , — and quality of life 9 , For people using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be consistent with respect to time and amount per meal 9 , , Checking glucose 3 h after eating may help to determine if additional insulin adjustments i.

Because these insulin dosing algorithms require determination of anticipated nutrient intake to calculate the mealtime dose, health literacy and numeracy should be evaluated.

The effectiveness of insulin dosing decisions should be confirmed with a structured approach to SMBG or CGM to evaluate individual responses and guide insulin dose adjustments.

In general, replacing saturated fat with unsaturated fats reduces both total cholesterol and LDL-C and also benefits CVD risk.

5 Ways to Lower Your A1C if You Have Type 2 Diabetes

Can you lower your A1C without pharmaceutical interventions and the possible side effects that they can bring? The first step is to talk with your healthcare provider. Everyone has their own unique circumstances that may make one health solution better than another.

Fortunately, research has shown that there are multiple ways to lower your A1C—many of which do not involve medication. According to the CDC, when sugar enters your bloodstream, it attaches to hemoglobin —a protein in your red blood cells.

Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.

Measuring your A1C levels helps you assess what your average blood sugar levels have been over the past few months 1. Blood cells typically last about months in your bloodstream before being replaced. During this time, they spend most of their lives zooming around the body via the bloodstream where they continuously bump into sugars that are also being transported through the bloodstream.

Sometimes, these encounters cause the sugars to get stuck to the surface of red blood cells. Scientists have found that the amount of sugar you have in your blood correlates with the percentage of hemoglobin within your blood cells that have sugar attached to them.

Put another way—the more sugar you have in your blood, the more sugar-coated hemoglobin you will have within your blood cells. The attachment of sugar to hemoglobin within red blood cells can happen when the cells are young or old. Because of this, measuring the percentage of hemoglobin in red blood cells that are coated in sugar can give you an idea about whether your blood sugar has been high or low for the past few months the lifespan of the red blood cells being analyzed.

When analyzing blood samples in the lab, sugar-coated hemoglobin in red blood cells gives off a signal that researchers can detect, which is known as the A1C signal. According to the American Diabetes Association , people without diabetes typically have an A1C of 5.

If your A1C levels fall between 5. A1C levels that are above 6. With rising A1C levels comes a greater risk for diabetes and its associated health conditions. Even though sugar is arguably one of the most important energy sources in the body, it can also damage body tissues when there is too much of it.

The flip side is that a decrease of just 0. Blood vessels in the retina—as another example—can deteriorate after prolonged exposure to high levels of sugar, leading to partial vision loss. Similarly, nerve cells throughout the body can be damaged by high blood sugar which, among other things, results in pain 3.

Given the negative effects of having high A1C levels, people with type 2 diabetes often want to lower their A1C levels. Exactly what you should target for your A1C levels depends on your unique circumstances.

Talk with your doctor to help you identify a personalized goal. As A1C levels are a reflection of blood-sugar levels over time, having chronically high A1C levels increases your likelihood of developing cardiovascular disease, kidney disease, vision loss, and peripheral nerve damage—all of which are common in unmanaged type 2 diabetes 3.

A1C levels are influenced by a number of factors including:. Fortunately, this means A1C levels are not set in stone—if your A1C levels are high, there are multiple ways to lower them. Lowering your A1C levels will take time, mostly because your A1C levels represent an average measurement of blood sugar over a month time period.

Because of this, momentary changes in blood sugar may not have a large effect on your A1C results. However, sustained efforts that help you lower your blood sugar levels for longer periods of time—such as dietary changes , medication, or restoration of beneficial bacteria to the gut microbiome —can lead to a drop in your A1C levels that may be noticeable after just a few months.

These questions have been the focus of research for decades. Through numerous clinical trials, various methods for managing A1C levels have been put to the test and some have shown very promising results. Weight loss has been shown in numerous studies to be correlated with a decrease in A1C levels.

This, in turn, leads to high A1C levels. Because excess body fat appears to suppress the effect of insulin, it makes sense that reducing body weight could potentially help re-sensitize the body to insulin signaling and result in a decrease of A1C levels 4.

This theory has been put to the test in clinical trials. An analysis of more than 50 clinical trials, involving more than 17, total participants, found that weight loss—via bariatric surgery or intensive lifestyle intervention—led to a decrease in A1C levels. This study went on to suggest that, based on these previous findings, people with type 2 diabetes may expect to decrease their A1C levels by ~0.

Some may require more weight loss to see a decrease in their A1C levels. The study similarly notes that a reduction in A1C levels was more likely in people who initially had very high A1C levels, suggesting that as you get nearer to the diabetes threshold of 6.

Nonetheless, reducing body weight does appear to be an effective way to reduce A1C levels 6. According to the American Diabetes Association, exercise is defined as any planned physical activity that increases your energy output. This can take the form of walking, running, swimming, weight lifting, or resistance training among many other forms 8.

When we exercise, our muscles have to burn energy to contract. That energy enables us to propel ourselves forward or to lift heavy objects. And that energy largely comes from sugar.

Muscle cells have their own stores of sugar that they turn to in times of need. However, those stores can be depleted relatively quickly.

Once that happens, they turn to the bloodstream for help. Muscle cells can remove sugar from the bloodstream when they need it, and this helps to lower blood sugar levels.

Experts advise that people with type 2 diabetes get approximately minutes of moderate to intense exercise spread out across at least three days a week in order to reduce their blood sugar levels 8.

Both aerobic exercises such as running, swimming, biking , as well as anaerobic exercises powerlifting, isometric training, resistance training , have been shown to help reduce A1C levels.

A major challenge to this method of blood sugar management is that its benefits are short-lived—once exercise has ceased, blood sugar levels are likely to rebound. When it comes to managing type 2 diabetes, a healthy eating plan is also a major focus for intervention.

This is because blood sugar levels are heavily influenced by the foods we eat: If we eat meals that are high in sugar content, our blood sugar is likely to be higher as well. Many studies have looked at the effect of balanced calorie restriction on A1C levels.

A calorie is a unit of measurement describing the amount of usable energy an item has. Our bodies can use fats and sugars as fuel. When we need more energy than our food provides, our body will turn to its internal resources such as sugars that are in the bloodstream or stored in the liver.

Reducing calorie count in a healthy, balanced manner can be a reasonable way to encourage your body to use its sugar stores and ultimately lower your blood sugar levels.

One clinical trial involving people with type 2 diabetes, known as the DIRECT study, had participants reduce their caloric intake to just calories per day for three to five months, followed by gradual reintroduction of higher calorie meals. Many studies have found that low-calorie diets, as well as carbohydrate-restricted diets, can be effective at reducing A1C levels for short periods of time but often fail to have a sustained impact 7.

Studies in which calorie restriction or low-carbohydrate diets were most effective also included professional guidance. Strict diets are difficult to adhere to, but incorporating certain foods into your diet may be easier.

Clinical trials have explored the effect of specific foods on A1C levels in people with type 2 diabetes. Primary among these are foods that are rich in soluble fibers.

Fibers are believed to help blood sugar levels in many ways. Additionally, certain dietary fibers may also encourage the growth of diverse and beneficial bacteria in the gut microbiome which can then have its own positive effects on blood sugar levels.

Large scale studies looking at the effect of dietary fibers on A1C levels have found that diets with large amounts of fiber specifically cereal fibers tend to cause a decrease in A1C levels of approximately 0.

Some foods that are high in fiber include:. Similar to foods high in fibers, foods that are high in resistant starches —complex sugars that are difficult for the human body to break down—are thought to have a positive impact on blood sugar levels.

However, clinical trials have shown mixed results wherein some studies have found a positive impact on participant A1C levels while others have not. Further research is needed to confirm whether resistant starches can help lower A1C levels.

In addition to a healthy eating plan and physical activity, supplements may be helpful in lowering your A1C levels. Numerous supplements have been put to the test in clinical trials; however, few have demonstrated a consistent benefit for people with type 2 diabetes.

Here are some of the tested supplements that have overall shown a positive effect:. You may recognize fenugreek as a common ingredient in Indian cuisine. Many cultures throughout the Mediterranean, southeastern Europe, and western Asia have recognized the medicinal properties in fenugreek.

Two clinical trials have found that fenugreek extract may help to lower A1C levels in people with type 2 diabetes. In addition to the high fiber content, fenugreek may have beneficial effects owing to some of the many compounds found within its seeds. This is both interesting and causes for caution:.

Researchers still need to examine how each of these compounds may affect the human body, especially when in the presence of other drugs such as metformin Similar to fenugreek, gymnema is a tropical plant native to southern Asia and parts of Africa.

Some people wake up with a higher morning blood sugar—this is called the dawn phenomenon. Also, people tend to be more insulin resistant in the morning; insulin is less effective at bringing sugar to the cells to use for energy.

Eating a lower carbohydrate meal means less sugar entering the bloodstream and less insulin needed. The end result is better blood sugars. Last, eating a high carbohydrate breakfast such as a bagel, or large bowl of cereal may actually cause more carbohydrate cravings throughout the day, resulting in higher blood sugars.

These types of foods cause blood sugars to spike at a quick rate. The aftermath is a drop in blood sugars which can cause cravings. It is hard to generalize when it comes to diabetes, but a lower carbohydrate, higher protein meal for breakfast is likely to be beneficial. It can help with morning insulin resistance and reduce cravings throughout the day.

However, a lower carbohydrate meal does not mean no carbohydrates. As opposed to eating a high-fat breakfast, aim to eat modified fat especially if you are trying to lose weight.

Fat is an important nutrient but has more than double the calories per gram than carbohydrate and protein. Complex carbohydrates that are rich in fiber and minimally processed are your best choices - particularly for breakfast.

Fiber helps to slow the rate at which glucose enters the bloodstream, which can help to achieve good blood sugar control. Fibrous foods keep you full and can aid in reducing bad cholesterol. Carbohydrates rich in fiber include fruits, vegetables, legumes beans , and whole grains.

The American Heart Association says that a diet rich in whole grains can help to reduce the risk of heart disease. Below are some examples of ideal breakfast options for people with diabetes, but be sure to consult with your Registered Dietitian or Physician before starting any new meal plan as individual needs do vary:.

Rabinovitz HR, Boaz M, Ganz T, et al. Big breakfast rich in protein and fat improves glycemic control in type 2 diabetics. Obesity Silver Spring. American Heart Association. Whole grains, refined grains and dietary Fiber. By Barbie Cervoni, RD Barbie Cervoni MS, RD, CDCES, CDN, is a New York-based registered dietitian and certified diabetes care and education specialist.

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Bioelectrical impedance Disclosures. Cntrol read the Disclaimer at A end of this page. All of dieh treatments and goals need riet be tempered based on Weight loss and body image fontrol, such as age, Ac and diet control expectancy, OMAD and eating windows comorbidities. Although studies of bariatric surgery, aggressive insulin therapy, and dier interventions ajd achieve weight xnd have noted remissions of type 2 diabetes mellitus that may last several years, the majority of patients with type 2 diabetes require continuous treatment in order to maintain target glycemia. Treatments to improve glycemic management work by increasing insulin availability either through direct insulin administration or through agents that promote insulin secretionimproving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, increasing urinary glucose excretion, or a combination of these approaches. For patients with overweight, obesity, or a metabolically adverse pattern of adipose tissue distribution, body weight management should be considered as a therapeutic target in addition to glycemia.

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