ADA 2019 Nutrition Therapy Consensus Report Application in

ADA 2019 Nutrition Therapy Consensus Report Application in

ADA 2019 Nutrition Therapy Consensus Report Application in the Real World Through Participatory Learning: Part 3 Shamera Robinson MPH, RDN Associate Director, Nutrition

American Diabetes Association Arlington, VA Kelly Rawlings MPH Head of Content Development Vida Health San Francisco, CA Disclosure to Participants

Notice of Requirements For Successful Completion Conflict of Interest (COI) and Financial Relationship Disclosures:

Shamera Robinson: MPH, RDN Employee of American Diabetes Association Kelly Rawlings: MPH Employee of Vida Health, Tweet chat presenter on behalf of LifeScan Diabetes Institute Non-Endorsement of Products:

Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use:

Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Objectives Participants will be able to: Discuss key concepts and new evidence from the ADA nutrition consensus statement. Discuss practical ways to apply new evidence to their

clinical practice. Describe how to address changes to nutrition guidance and individualize guidance in real life settings. Empowered Eater No. 1: Earl My wife calls me the Q King. Im known for my dry-rub ribs. So the caveman diet sounds good. No bread, potatoes, stuff thats white. 62yro male, T2D Dx 2017, metformin BMI 31 (1pt), A1C 9.1, BP 145/90, Chol 204

No previous MNT, 1-hr. DSMES experience Earl: Strengths-Based Intel Interested in food, flavor, feeding others Understands some foods carb Change talk: caveman diet Consensus Recommendation Until evidence surrounding comparative benefits of different eating patterns in specific individuals

strengthens, focus on the key factors that are common among the patterns: Emphasize nonstarchy vegetables Minimize added sugars and refined grains Choose whole foods over highly processed foods to the extent possible Earl: Individualized Guidance Emphasize nonstarchy vegetables Dont like texture, taste

Veggies can be grilled, seasoned with rubs Minimize added sugars and refined grains Buns, cornbread, and potato salad! Consider choosing one favorite, less carby sides Whole foods over highly processed foods Interested in making own side dishes? Consensus Recommendations

Refer adults T1D and T2D to MNT at Dx and as needed throughout life span and during times of changing health status to achieve treatment goals Refer adults w/ diabetes to DSMES, per national standards MNT by RDN yields A1C absolute decrease up to 2% in T2D, up to 1.9% in T1D at 36 months Consensus Recommendation there is not an ideal % 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. WWYD? Someone brings up wanting to follow a VLC diet, what would you do? A. Share all the risks

B. Offer an alternative, such as diabetes plate method C. Assess intake, support by offering individualized goals D. Provide handouts/food lists for VLC diet Consensus Recommendation A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes. Empowered Eater No. 2: Elaine

Gastroparesis was a shock. I worried about going blind, not my stomach. Ive always been a healthy eater. I eat veggies. I carb count. I dont let myself have sweets. 51yro female, T1D Dx 1982, MDI BMI 26, A1C 8, BP 117/74, Chol 160 Diabetes education decades ago Elaine: Strengths-Based Intel Understands cause-effect of food and BGs

Skilled in planning, choosing what to eat Years-long attention to self-management Consensus Recommendations During MNT and DSMES, screen and evaluate for disordered eating; nutrition therapy should accommodate these disorders Prevalence in diabetes varies, 1840% Selection of small-particle-size food may improve symptoms of diabetes-related gastroparesis

Correcting hyperglycemia (slows gastric emptying) CGM/pump may aid dosing and timing of insulin Elaine: Individualized Guidance Assess for disordered eating I dont let myself have sweets Small-particle-size foods Baby food! What is acceptable? Cooking vegetables, smoothies

Address hyperglycemia CGM/pump Shots dont bother me. Explore interest in/access to pump/CGM Empowered Eater No. 3: Euna We have 4 beautiful babiesoldest is 17 youngest is 5 going on 50! I want my kids to eat healthy, do well in school. But I cant make

6 dinners to keep everyone happy. 37yro female, prediabetes Dx 2014 BMI 34, A1C 6.0, BP 150/94, Chol 200 Euna: Strengths-Based Intel Takes family caregiving roles very seriously Understands value of modeling healthy eating, education Has potential social support system via her family members

Consensus Recommendation To support weight loss and improve A1C, CVD risk factors, and quality of life in adults with overweight/ obesity and prediabetes or diabetes, MNT and DSMES services should include an individualized eating plan in a format that results in an energy deficit in combination with enhanced physical activity. 7-10% weight loss (unless additional weight loss is desired for other reasons).

Whats an Individualized Plan? Individualized eating plans consider: Energy deficit Dietary preferences Health literacy/numeracy Resources Food availability Cooking skills Disordered eating Sustainability

Euna: Individualized Guidance Focus on 12 goals, created by Euna Eat healthier? Explore quick, convenient options (frozen vegetables) Weight loss? Reduce sat. fat in small ways (helps reduce CVD risk) Move more? Strategies that use available opportunities (walk at work) or provide family time (active play w/ kids) 7-10% weight loss is goal, but health of the whole person must always come first

WWYD? Ed, T1D, on-target A1C/BP/lipids, BMI 32 What nutrition counseling may be warranted? A. B. C. D. Focus on medication management

Explore weight management plan Encourage: keep doing what youre doing! Provide handouts/food lists for low-carb diet

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