PDF(Pubmed)
Abstract：
Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals\' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.
摘要：
营养干预是2型糖尿病管理的关键组成部分;在饮食模式中进行健康支持的改变可以改善餐后血糖波动并降低HbA1c以降低糖尿病相关的发病率和死亡率。关于实施卡路里限制和/或低碳水化合物饮食的研究是大量的，尽管维持生理和行为变化超过12个月的能力是一个问题。需要了解干预目标和依从性，才能将这项研究应用于患者护理，并将期望转化为现实世界的生活环境。多样化的饮食模式，包括地中海饮食模式，素食或植物性饮食模式，或其他强调高质量碳水化合物(例如，全谷物)，蔬菜,整个水果,豆类,和鱼可以支持血糖目标的实现。诸如动机面试之类的咨询策略可以用来建立饮食能力。这些方法优先考虑协作决策，目的是增加患者赋权和自我效能感。强调了在临床环境中纳入这些工具和框架的策略。提供持续的糖尿病和营养教育，配合适当的支持，以应对实施和维持行为变化方面的挑战，是有保证的。Further,健康的社会决定因素，包括环境背景，教育,社会经济地位,获得医疗保健，和系统污名化的经历(例如，种族主义或体重偏见)会干扰个体的糖尿病自我护理和营养行为。提供医学营养治疗和根据个人需求和情况定制营养干预措施可能是医生的重要途径，营养师,糖尿病提供者可以支持2型糖尿病患者。
