Nutritional Strategies for Prevention and Management of Diabetes: Consensus and Uncertainties

The nutrition Consensus Report (1) and four featured papers (2–5) in the special section on nutrition in this issue of Diabetes Care focus on nutrition therapy and medical nutrition therapy (MNT) in the management and prevention of diabetes. The Consensus Report, which is intended to update and replace the 2014 American Diabetes Association (ADA) nutrition position statement (6), examines “studies published in English between 1 January 2014 and 28 February 2018” to “provide clinical professionals with evidence-based guidance” (1) related to the 42 questions listed in Table 1. The ADA has indicated, “A consensus report is not an ADA position and represents expert opinion only” and does not include the ADA evidence-grading system (7). We examine the Consensus Report and nutrition articles featured in this issue considering epidemiological trends, population health versus professional intervention approaches, implications of feeding studies and interventional trials, and potential for personalization/individualization of nutritional approach based on genetic, metabolomic, and microbiomic variation or personal/cultural preferences. View this table: Table 1 Questions addressed by the nutrition Consensus Report expert panel The 2014 statement (6) focused on nutrition therapy for “adults with diabetes” whereas the 2019 Consensus Report has a broader scope and addresses nutrition therapy for “adults with diabetes or prediabetes” (1). Inclusion of adults with prediabetes expands the population base for nutrition therapy to 43.3% of U.S. adults based on the Centers for Disease Control and Prevention prevalence estimates that 9.4% of U.S. adults have diabetes and 33.9% of U.S. adults have prediabetes (8). A recent systematic review and meta-analysis published in Diabetes Care (9) synthesized the global evidence on the impact of lifestyle modifications on reducing the incidence of diabetes in a parsimonious model to inform resource allocation. Although evidence from clinical trials shows that type 2 diabetes is largely preventable clinically, population-level reductions in the …