Clinical Support

Nutrition & Wellness

The American Diabetes Association (ADA) translates evidence-based diabetes nutrition standards into practical and accessible tools and resources for diabetes health care professionals and stakeholders.  

African American female nutritionist weighing avocado on scale

Our Nutrition & Wellness Philosophy

We believe informed food choices are essential to living well. These behaviors are personalized, equitable, shaped through the lens of culture and community, and are guided by national standards and recommendations for health and wellbeing.

Scientific Foundations for Nutrition Education and Therapy

The ADA relies on a group of external diabetes experts to critically examine the total evidence as they write the annual updates to the Standards of Care in Diabetes (Standards of Care). Every five years, there is an in-depth review of the totality of evidence for the nutrition management of diabetes. This Nutrition Consensus report outlines the fundamentals for practitioners as they guide and support an individual’s approach to their own diabetes self-management strategies. You can find nutrition resources in our online store, the Abridged Standards of Care 2024 Section 5: Facilitating Positive Health Behaviors and Well-Being to Improve Health Outcomes Infographic, and nutrition training from our Institute of Learning. 

Goals of Nutrition Management in People with Prediabetes and Diabetes

All health care team members involved in diabetes nutrition management should use evidence-based meal patterns that emphasize a variety of nutrient-dense foods in appropriate portions sizes to: 

  • Improve overall health, A1C, blood pressure, and cholesterol levels.
  • Achieve and maintain body weight and composition goals.
  • Delay or prevent diabetes complications.

Healthy eating encompasses more than just food. It involves personal and cultural preferences, health literacy and numeracy, access to healthy food choices, willingness and ability to make behavioral changes, as well as understanding the barriers to change.

Additionally, it is important to maintain the pleasure of eating by providing positive messages about food choices within the selected meal pattern(s) and provide practical tools for day-to-day meal planning. This includes an understanding of how food not only nourishes the body, but the whole person through memories, culture, and community.

The Nutrition Consensus report outlines seven key meal patterns individuals may use as they find the best strategies that work for them. Overall, there are several key factors that are common among the patterns:

  • Emphasize selecting non-starchy vegetables and lean protein options.
  • Emphasize choosing, when selected, quality carbohydrate foods. 
  • Focus on starchy vegetables, legumes, peas and lentils, whole grains, fruits, and milk. 
  • Minimize added sugars and refined grains and associated foods.
  • Choose whole and minimally processed foods.
  • Minimize added saturated fat and added sodium.
  • Emphasize choosing foods to support dietary fiber requirements.

Reducing the overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences. 

Healthy eating patterns for people with diabetes can also be used for people with prediabetes. Early treatment focused on moderate lifestyle changes can return blood glucose levels to a desirable range. Small changes such as losing 5% of weight and increasing physical activity can have a huge impact on delaying or preventing type 2 diabetes altogether. Learn more and locate a Centers for Disease Control and Prevention (CDC)-recognized lifestyle change program guided by a lifestyle coach trained to use an evidence-based  curriculum.

2019 Nutrition Consensus-Recommended Meal Patterns

Meal Pattern

Hightlights

Potential Benefits

Mediterranean-style
  • Plant-based foods (vegetables, beans, nuts and seeds, fruits, and whole grains)
  • Fish and other seafood
  • Olive oil as the principal source of dietary fat
  • Dairy products (mainly yogurt and cheese) in low to moderate amounts
  • Typically fewer than four eggs/week
  • Red meat in low frequency and amounts
  • Wine in low to moderate amounts
  • Concentrated sugars or honey rarely
  • Reduced risk of diabetes
  • A1C reduction
  • Lowered triglycerides
  • Reduced risk of major cardiovascular events
Vegetarian or veganMeal pattern that highlights plant-based foods, excluding all animal-based products (vegan), or a pattern that excludes meats, seafood, or poultry but includes eggs and/or dairy products (vegetarian).
  • Reduced risk of diabetes
  • A1C reduction
  • Weight loss
  • Lowered LDL-C and non-HDL-C
Low-fat
  • Vegetables
  • Fruits
  • Starches (e.g., breads/crackers, pasta, whole grains, starchy vegetables)
  • Lean protein sources (including beans)
  • Low-fat dairy products

In this review, it was defined as total fat intake less than 30% of total calories and saturated fat intake less than 10%.

  • Reduced risk of diabetes
  • Weight loss
Very low-fat
  • Fiber-rich vegetables
  • Beans
  • Fruits
  • Whole grains
  • Non-fat dairy
  • Fish
  • Egg whites

This pattern comprises 70–77% carbohydrate (including 30–60 g fiber) and less than 10% total calories from fat.

  • Weight loss
  • Lowered blood pressure
Low-carbohydrate
  • Non-starchy vegetables low in carbohydrates
  • Healthy fats
  • Protein in the form of meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds
  • Quality carbohydrates are included but limited. 

In this review, a low-carbohydrate eating pattern is defined as reducing carbohydrates to 26–45% of total calories.

  • A1C reduction
  • Weight loss
  • Lowered blood pressure
  • Increased HDL-C and lowered triglycerides
Very low-carbohydrateMeal pattern that is similar to the low-carbohydrate pattern but further limits carbohydrate-containing foods. Meals typically contain more than half of calories from fat. This pattern often has a goal of 20–50 g of non-fiber carbohydrate per day. In this review, a very low-carbohydrate eating pattern is defined as reducing carbohydrate to less than 26% of total calories.
  • A1C reduction
  • Weight loss
  • Lowered blood pressure
  • Increased HDL-C and lowered triglycerides
Dietary Approaches to Stop Hypertension (DASH)
  • Vegetables
  • Fruits
  • Low-fat dairy products
  • Whole grains
  • Poultry
  • Fish
  • Nuts
  • Reduced saturated fat, red meat, sweets, and sugar-containing beverages. (May also be reduced in sodium.)
  • Reduced risk of diabetes
  • Weight loss
  • Lowered blood pressure

Meal Planning Strategies

To help integrate meal patterns into a daily routine, you can use different meal planning tools.

  • The Diabetes Plate
    The Diabetes Plate is not only a visual tool representing the low-carbohydrate meal pattern, it can also be used as a framework for all meal patterns. By using the specific strategies outlined in each meal pattern, the Diabetes Plate could be adapted to help illustrate how each could come to life as a visual tool for a specific eating occasion. This approach works well for most people, but especially for those who have lowered health numeracy or literacy.
  • Carbohydrate counting 
    For those on an adaptive insulin regime, carbohydrate counting may be a good strategy, regardless of the meal pattern they select to use. 

Integrating Nutrition as a Whole-Person Approach in Diabetes Management

Healthy eating is not the only thing that impacts blood glucose. It is important to understand and provide education on how other elements of daily living impact healthy eating as well. These include:

  • Diabetes Management Coping & Problem Solving—The daily challenges of managing diabetes can cause distress and influence how a person feels about their overall wellbeing. For those with limited coping skills, it can prevent them from making healthy eating choices. Encourage people to develop proactive coping strategies that help with daily decision making, stressors, and barriers to healthy eating.
  • Physical Activity—Physical activity is part of daily blood glucose management and overall health. Provide support and education on healthy foods to help fuel daily opportunities to move and be physically active.
  • Medications—Provide support to understand how medications work in cooperation with meal timing and food choices, and how they help to better manage diabetes and prevent complications.
  • Monitoring—Reinforce the importance of keeping track of daily activities, eating, and stress level, and how it provides feedback on the conditions that influence blood glucose levels.
  • Short Term & Long-Term Health Risks—Provide support to the people you see on how to prevent, detect, and treat both immediate and long-term risks, and the importance of preventing complications. Emphasize how healthy eating helps to prevent complications such as hypo or hyperglycemia on a day-to-day basis, and how this can reduce the chance of developing other major health issues.
  • Pathophysiology—The biology of diabetes treatment evolves as the condition progresses. Educate on what to expect at different phases of diabetes interventions. When people understand how the body responds to treatment it will help empower them to advocate for the therapies and strategies that contribute to their own health goals. Healthy eating, physical activity, medication, and other factors may need to be adapted to better support their diabetes management success.