Diabetes

Glycemic control and reduction of cardiovascular disease risk are the major treatment goals for all types of diabetes. In addition to nutritional management (termed medical nutrition therapy [MNT] in the United States), these goals are accomplished through several modalities including a variety of pharmacological agents, close personal and laboratory monitoring, and care provided by a team of health professionals. All of these elements, integrated and coordinated, are essential in the management of diabetes. There is not one diet for individuals with diabetes. Nutritional management should be based on individual assessment and development of an individualized treatment plan. The distribution of macronutrient intake may vary based on a number of factors, including matching insulin to lifestyle in type 1 diabetes (T1D) and weight loss in type 2 diabetes (T2D). Assessing micronutrient status is needed for patients in poor control, with complications, or with other evidence of being at risk. This chapter will discuss the etiology, diagnosis, and attainment of glycemic control (with an emphasis on MNT) of T1D, T2D, and gestational diabetes (GDM). It will then discuss the role of nutrition in the prevention of complications and reduction of chronic disease risk factors for both T1D and T2D and the role of specific dietary components including herbal and other supplements and micronutrients in diabetes care. The chapter will conclude with a discussion of global public health issues relating to diabetes, and research needs and future direction of the role of nutrition in this complex disorder.