Nutritional Advice and Structured Training

Each patient with type 2 diabetes needs individual advice and structured training by his or her physician and other members of the healthcare team, to enable them to translate the principles of nutrition in type 2 diabetes into specific actions in daily life (Table 4).

A balance must be achieved among the demands of metabolic control, risk factor management, and the patient's well-being and safety. The therapeutic needs of an individual person will change with time and, therefore, continuing nutritional education must be provided (38,39). To improve compliance, the main aspects of dietary advice given to a person with diabetes should also have a potential benefit for family members and should be acceptable to them.

A nutritional history should be taken at diagnosis, as well as at visits whenever the patient is not well controlled and it is thought that nutritional factors might have contributed to the unsatisfactory metabolic results. A nutritional review and individual nutritional recommendations should be provided at least once a year, or more often on special request (38).

Individual advice can be combined with structured group training. Since the clinical picture and the personal situation of the individual with diabetes may change during the course of the disease, different priorities are required in the training programs.

All steps in the nutritional management of a person with type 2 diabetes should be documented and the outcome evaluated by means of important markers, such as body weight, waist circumference, blood pressure, HbA_1c, fasting, and/or postprandial blood glucose (self-) monitoring, serum-lipids, AER and well-being or quality of life.

Monika Toeller

German Diabetes Research Center, Heinrich-Heine University, Düsseldorf, Germany
Jim I. Mann
Department of Human Nutrition, University of Otago, Dunedin, New Zealand

REFERENCES

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