Over the last 25 years, the American Diabetes Association’s (ADA’s) “Standards of Medical Care in Diabetes”1 remain a reference point in diabetes management, as they are updated annually, aiming to provide clinicians, patients and researchers with the latest evidence-based principles on diabetes care, prevention and treatment.
Low calorie sweeteners’ role in the diet: what ADA’s new standards support
Low calorie sweeteners can be a helpful tool in the diet of people with diabetes, as they do not increase blood glucose or insulin levels. The American Diabetes Association recognises that “for people who are accustomed to sugar-sweetened products, non-nutritive sweeteners have the potential to reduce overall calorie and carbohydrate intake and may be preferred to sugar when consumed in moderation”.2 Furthermore, ADA acknowledges low calorie sweeteners’ safety, as already confirmed by food safety authorities around the world, further adding that “regulatory agencies set acceptable daily intake levels for each non-nutritive sweetener, defined as the amount that can be safely consumed over a person’s lifetime.”
Based on the available literature3, 4, ADA concludes in its Medical Nutrition Therapy (MNT) recommendations, “The use of non-nutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners and without compensation by intake of additional calories from other food sources. Non-nutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.”
New recommendations on lifestyle management in this year’s guidelines
The 2017 Standards of Care incorporate several new guidelines issued in 2016 by ADA, including those on lifestyle management. “This year, the Standards include critical, new evidence-based additions—psychosocial care, expanded physical fitness, metabolic surgery and hypoglycemia—all of which can impact effective diabetes care” said the Association’s Chief Scientific and Medical Officer Robert E. Ratner, MD, FACP, FACE, in a Press Release issued by ADA.
In relation to physical activity, it is the first time that ADA’s guidelines include a recommendation to reduce the time spent in daily sedentary behaviour. Specifically, it is stated that prolonged sitting should be interrupted every 30 min for blood glucose benefits, particularly in adults with type 2 diabetes. Further ADA’s guidelines include, as in 2016, the recommendation for 150 min or more of moderate-to-vigorous intensity physical activity, spread over at least 3 days/week, ideally combined with resistance exercise (2–3 sessions/ week), flexibility and balance training at least twice on a weekly basis.
When it comes to nutrition therapy in diabetes, it is recognised that diet has an integral role in diabetes management. However, for many individuals knowing what to eat remains the most challenging part of the overall treatment plan.
Here below some key, evidence-based, nutrition principles about energy and nutrient intake in diabetes management:
- Reducing calorie intake compared to energy consumed with physical activity is the first step in achieving modest weight loss, an important goal for overweight or obese adults with type 2 diabetes or those with prediabetes.
- An eating plan emphasizing elements of a Mediterranean-style diet rich in monounsaturated fats may improve glucose metabolism and lower cardiovascular disease risk.
- Opt for carbohydrates from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber over those containing sugars. Low calorie sweeteners can be used to replace sugar in food and beverages as they do not affect blood glucose levels nor provide calories.
- Eating foods rich in omega-3 fatty acids, such as fatty fish, nuts and seeds is recommended for reducing cardio-metabolic risk in people with diabetes.
Importantly, a “one-size-fits-all” approach is not applicable in nutrition therapy for diabetes management and an individualised eating plan, preferably provided by a dietitian, is a key component of the overall treatment plan, helping towards a better glycaemic control.