3.3.0.0 Eat­ing Pat­terns and Meal Plan­ning

Ev­i­dence sug­gests that there is not an ideal per­cent­age of calo­ries from car­bo­hy­drate, pro­tein, and fat for all peo­ple with di­a­betes. There­fore, macronu­tri­ent dis­tri­bu­tion should be based on an in­di­vid­u­alized as­sess­ment of cur­rent eat­ing pat­terns, pref­er­ences, and metabol­ic goals. Con­sid­er per­sonal pref­er­ences (e.g., tra­di­tion, cul­ture, re­li­gion, health be­liefs and goals, eco­nomics) as well as metabol­ic goals when work­ing with in­di­vid­u­als to de­ter­mine the best eat­ing pat­tern for them (35,51,52). It is im­por­tant that each mem­ber of the health care team be knowl­edgeable about nu­tri­tion ther­a­py prin­ci­ples for peo­ple with all types of di­a­betes and be sup­portive of their im­ple­mentation. Em­pha­sis should be on health­ful eat­ing pat­terns con­tain­ing nu­tri­ent-‍dense foods, with less focus on specific nu­tri­ents (53). A va­ri­ety of eat­ing pat­terns are ac­cept­able for the man­age­ment of di­a­betes (51,54), and a re­fer­ral to an RD or reg­is­tered di­eti­tian nu­tri­tionist (RDN) is es­sen­tial to as­sess the over­all nu­tri­tion sta­tus of, and to work col­lab­o­ra­tively with, the pa­tient to cre­ate a per­sonalized meal plan that con­sid­ers the in­di­vid­u­al’s health sta­tus, skills, re­sources, food pref­er­ences, and health goals to co­or­di­nate and align with the over­all treat­ment plan in­clud­ing phys­i­cal ac­tiv­i­ty and med­i­ca­tion. The Mediter­ranean (55,56), Di­etary Ap­proach­es to Stop Hy­per­ten­sion (DASH) (57-59), and plant-‍based (60,61) diets are all ex­am­ples of health­ful eat­ing pat­terns that have shown pos­i­tive re­sults in re­search, but in­di­vid­u­alized meal plan­ning should focus on per­sonal pref­er­ences, needs, and goals. In ad­di­tion, re­search in­di­cates that low-car­bo­hy­drate eat­ing plans may re­sult in im­proved glycemia and have the po­ten­tial to re­duce an­ti­hy­per­glycemic med­i­ca­tions for in­di­vid­u­als with type 2 di­a­betes (62-64). As re­search stud­ies on some low-‍car­bo­hy­drate eat­ing plans gen­er­ally in­di­cate chal­lenges with long-term sus­tainabil­i­ty, it is im­por­tant to reas­sess and in­di­vid­u­alize meal plan guid­ance reg­u­lar­ly for those in­ter­est­ed in this ap­proach. This meal plan is not rec­om­mend­ed at this time for women who are preg­nant or lac­tat­ing, peo­ple with or at risk for dis­or­dered eat­ing, or peo­ple who have renal dis­ease, and it should be used with cau­tion in pa­tients tak­ing sodi­um–glu­cose co­trans­porter 2 (SGLT2) in­hibitors due to the po­ten­tial risk of ke­toaci­do­sis (65,66). There is inad­e­quate re­search in type 1 di­a­betes to sup­port one eat­ing plan over an­oth­er at this time.

A sim­ple and ef­fective ap­proach to glycemia and weight man­age­ment em­pha­siz­ing por­tion con­trol and healthy food choic­es should be con­sid­ered for those with type 2 di­a­betes who are not tak­ing in­sulin, who have lim­it­ed health lit­er­a­cy or nu­mer­a­cy, or who are older and prone to hy­po­glycemia (50). The di­a­betes plate method is com­mon­ly used for pro­vid­ing basic meal plan­ning guid­ance (67) as it pro­vides a vi­su­al guide show­ing how to con­trol calo­ries (by fea­tur­ing a small­er plate) and car­bo­hy­drates (by lim­it­ing them to what fits in one-‍quar­ter of the plate) and puts an em­pha­sis on low-‍car­bo­hy­drate (or non­-starchy) veg­etables.