Historical Perspective

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The ADA's nutrition recommendations for diabetes management have changed a great deal since the first recommendations were introduced in the 1920s. Some of the more recent changes directly contradict long-established standards of diabetes nutrition care.

In 1971, the ADA's nutrition recommendations for diabetes management called for a moderate carbohydrate intake of approximately 45% of total calories, 20% of calories from protein, and 35% from fat. Diabetic patients were encouraged to avoid sucrose and concentrated sweets; however, little emphasis was placed on the amount of protein and both total and saturated fat included in the diet. In 1986, the ADA's nutrition recommendations were revised to encourage a carbohydrate intake of approximately 60% of calories, along with reductions in protein and fat intake to 12-20% and less than 30% of total calories, respectively. The amount of protein and fat recommended in the meal plan was decreased to limit the risk of cardiac and renal complications of diabetes. Patients with diabetes were also encouraged to consume a diet high in fiber and to limit their intake of sucrose and foods that contained sugar (2).

In 1994, the ADA significantly revised its nutrition recommendations for diabetes management to reflect current research that indicated good blood glucose control can be achieved with varying percentages of calories from carbohydrate, protein, and fat in the meal plan. The ADA's nutrition recommendations currently emphasize a flexible approach to the nutrition prescription, with a meal plan that includes varying amounts of macronutrients based on a nutrition assessment and individualized treatment goals. Sucrose and foods containing sugar can now be consumed as part of the total carbohydrate content of the meal plan. Diabetic patients are also encouraged to moderate the amount of protein and limit both the total fat content and the amount of saturated fat in their diet (2).

These repealed revisions have resulted in confusion for health-care practitioners and patients, which often limits a diabetic patient's ability to optimize his or her diabetes control.

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