To control body weight, lipid profiles, A1C levels in type 2 diabetics, try a highly structured nutritional plan

Liz Meszaros, MDLinx | June 28, 2016

In overweight/obese patients with uncontrolled type 2 diabetes, a highly structured nutritional plan made the most significant impact on body weight, lipid profiles, and A1C levels, without the need for increased medications, exercise, or behavioral change, according to data presented at the 76th Scientific Sessions of the American Diabetes Association.


Structured nutritional plan

Highly structured meal planning

Specify macronutrient ratios, caloric levels, and require them to keep a food log.

In the Nutrition Pathway Study, lead researcher Osama Hamdy, MD, PhD, medical director of the Obesity Clinical Program at Joslin Diabetes Center and colleagues compared three models of nutrition therapy in overweight and obese adults with uncontrolled type 2 diabetes previously treated with various oral and injectable agents, except insulin. They randomized the 108 patients evenly into three groups, with each group comprised of 36 patients:

  • Group 1 followed a traditional nutrition model, and met with a registered dietician (RD) who reviewed their eating habits and preferences, and provided individualized advice on eating plans.
  • Group 2 met with an RD, were given highly structured meal plan based on macronutrient ratios and caloric levels as specified in the Joslin Clinical Nutrition Guideline for Overweight/Obese Adults with Type 2 Diabetes, and were required to keep food logs. They received instructions on the specific contents of their meals according to macronutrient and caloric composition, along with menu books, a list of snacks, and a supply of 1 to 3 diabetes-specific calorie replacement foods per day. Like those in Group 1, they were also asked to keep a food log.
  • Group 3 patients followed a highly structured meal plan, and received weekly coaching phone calls from their RD.

In Group 1, A1C levels did not change, but in Groups 2 and 3, they decreased significantly, by an average of 0.67%. Body weight did not change significantly in Group 1, but decreased significantly in Groups 2 and 3, by an average of 3.5 kg over 16 weeks

“This drop in A1C due to nutrition therapy alone is much better than what we have been able to achieve with many of the current medications for type 2 diabetes,” said Dr. Hamdy. “This is very encouraging since participants in the study have lived with type 2 diabetes for more than 10 years and were not able to control their blood glucose or weight with multiple medications.”

 “It was surprising to see all these significant changes in A1C and body weight without altering medications or activity level and without aiming for weight reduction, which tells us that nutrition therapy can be as effective as medications even after a long duration of the disease,” he concluded.