2.3.0.0 Nu­tri­tion

Struc­tured be­hav­ioral weight loss ther­a­py, in­clud­ing a re­duced calo­rie meal plan and phys­i­cal ac­tiv­i­ty, is of paramount im­por­tance for those at high risk for de­vel­op­ing type 2 di­a­betes who have over­weight or obe­si­ty (1,7). Be­cause weight loss through lifestyle changes alone can be difficult to main­tain long term (4), peo­ple being treat­ed with weight loss ther­a­py should have ac­cess to on­go­ing sup­port and ad­di­tion­al ther­a­peu­tic op­tions (such as pharmacother­a­py) if need­ed. Based on in­ter­ven­tion tri­als, the eat­ing pat­terns that may be help­ful for those with predi­a­betes in­clude a Mediter­ranean eat­ing plan (8-11) and a low-‍calo­rie, low-‍fat eat­ing plan (5). Ad­di­tion­al re­search is need­ed re­gard­ing whether a low-‍car­bo­hy­drate eat­ing plan is beneficial for per­sons with predi­a­betes (12). In ad­di­tion, ev­i­dence sug­gests that the over­all qual­i­ty of food con­sumed (as mea­sured by the Al­ter­na­tive Healthy Eat­ing Index), with an em­pha­sis on whole grains, legumes, nuts, fruits and veg­eta­bles, and min­i­mal refined and pro­cessed foods, is also im­por­tant (13-15).

Whe­re­as over­all healthy low-‍calo­rie eat­ing pat­terns should be en­cour­aged, there is also some ev­i­dence that par­tic­u­lar di­etary com­po­nents im­pact di­a­betes risk in ob­ser­va­tion­al stud­ies. High­er in­takes of nuts (16), berries (17), yo­gurt (18,19), cof­fee, and tea (20) are as­so­ci­at­ed with re­duced di­a­betes risk. Con­verse­ly, red meats and sugar-‍sweet­ened bev­er­ages are as­so­ci­at­ed with an in­creased risk of type 2 di­a­betes (13).

As is the case for those with di­a­betes, in­di­vid­u­al­ized med­i­cal nu­tri­tion ther­a­py (see Sec­tion 5 “Lifestyle Man­age­ment” for more de­tailed in­for­ma­tion) is ef­fec­tive in low­er­ing A1C in in­di­vid­u­als di­ag­nosed with predi­a­betes (21).