Page 514 - Nutrition Essentials for Nursing Practice

502 U N I T 3 Nutrition in Clinical Practice

Box 19.2 LIFESTYLE RECOMMENDATIONS TO PREVENT TYPE 2 DIABETES

■ Make lifestyle changes to produce a moderate weight loss of 5% to 15% of initial
weight, with a target of 1 to 2 pounds/week.

■ Engage in moderate physical activity (e.g., brisk walking) for at least 30 minutes
per day, 5 days per week.

■ Limit fat to Ͻ30% of total calories.
■ Reduce portion sizes and daily calorie intake.
■ Increase intake of fruit, vegetables, and fiber.

Source: Ahmad, L., & Crandall, J. (2010). Type 2 diabetes prevention: A review. Clinical Diabetes, 28, 53–59.

of diabetes by 58% (DPP Research Group, 2002). Study participants walked at moderate
intensity, an average of 150 minutes/week, and decreased their intake of fat and calo-
ries. Average weight loss was a modest 5% to 7% of initial weight, or about 15 pounds.
Participants also benefited from improvements in their lipid profiles, blood pressure, and
markers of inflammation (Haffner et al., 2005; Ratner et al., 2005). The DPP results were
so quick and convincing that the program was halted a year early. A 10-year follow-up
on the original participants showed that the lifestyle intervention group maintained a de-
creased risk of diabetes over time (DPP Research Group, 2009). Clearly, millions of over-
weight Americans at high risk for type 2 diabetes can delay and possibly prevent the disease
with a modest weight loss brought about by a moderate diet and regular exercise.

There is no one proven strategy that can be uniformly recommended to promote
weight loss in all clients. Although standard weight loss diets that provide 500 to 1000
fewer calories than usual daily intake can promote a weight loss of as much as 10% in
6 months, most people regain weight without continued support and follow-up (Bantle
et al., 2008). Very-low-calorie diets (ϳ800 cal/day) produce substantial weight loss and
rapid improvements in blood glucose and lipid levels in people with type 2 diabetes, but
weight gain is common after the diet stops. For some patients, weight loss is achieved by a
more flexible strategy using MyPlate as a guide for increasing fruits, vegetables, and whole
grains while limiting fats and sweets (see Chapter 8). An individualized approach takes into
account the client’s treatment goals and his or her ability and willingness to change.

The type of fat consumed may also influence diabetes risk (Bantle et al., 2008). Spe-
cifically, a low saturated fat intake may reduce the risk for diabetes by improving insulin
resistance and promoting weight loss. Beyond its potential beneficial effects on diabetes
risk, a low saturated fat diet is well established as a strategy to lower the risk of heart disease
(National Cholesterol Education Program, 2001).

Several studies show that an increased intake of whole grains and fiber lowers the risk
of diabetes (Bantle et al., 2008). Whole grains correlate to improved insulin sensitivity,
regardless of body weight. Fiber has been associated with improved insulin sensitivity and
improved ability to secrete insulin to overcome insulin resistance (Liese et al., 2003).

Managing Diabetes

The primary goal of diabetes management is to keep blood glucose levels as near normal as
possible. Additional goals are to

■ Attain and maintain reasonable weight
■ Attain and maintain control of blood lipid levels and blood pressure
■ Prevent or delay the development of acute and chronic complications