Diabetes is a monumental health crisis impacting our country. The CDC reports that 37.3 million Americans (11.3% of the US population) have diabetes, and 96 million American adults (38% of the US population) have prediabetes.1 Diabetes is the seventh leading cause of death in the United States and costs an estimated $327 billion annually in medical costs and lost work and wages. In fact, people with diagnosed diabetes have more than twice the average medical costs than people without diabetes.2 These staggering statistics are proof that diabetes prevention, management, and care must be prioritized to help improve the health of Americans and mitigate economic costs. For healthcare professionals to help patients better manage their blood sugar and overall diabetes care, they must stay abreast of the latest research and tools in diabetes care. Read on for an overview of diabetes, the latest updates in clinical practice guidelines and innovations in diabetes management, and tips to implement in counseling.
Diabetes – A Professional Refresher
Diabetes is a group of diseases characterized by high blood sugar (or blood glucose). Blood glucose is the main source of energy used to fuel our bodies that we get from the foods and drinks we consume. Insulin, a hormone made by the pancreas, helps glucose get into our cells to be used for energy. When the body does not have enough insulin or cannot use it properly, blood sugar (glucose) builds up in the blood. When a person has diabetes, the body either does not make enough insulin (type 1) or is unable to properly use insulin (type 2). 3 Too much glucose then stays in your blood, and not enough reaches your cells. Type 2 diabetes is the most common type of diabetes and what we will be primarily referencing in this article. Prediabetes is a condition in which blood sugar is higher than normal but not high enough to be classified as diabetes.4
Traditionally type 2 diabetes occurs in middle-aged and older people, though it can occur at any age, and we are seeing growing rates of children who are impacted with the disease. Various factors are at play for diabetes to occur but the most common are lifestyle factors such as having a sedentary lifestyle, being overweight or obese, as well as genetic factors- having a family history of diabetes, or being African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander.5
The Latest Updates in Clinical Practice Guidelines for Diabetes Management
As an expert who sees clients regularly, Orgain Nutrition Advisory Board Member and Certified Diabetes Care Specialist, Kim Rose, RDN, CDCES, CNSC, LD, noted that diabetes care is changing rapidly. It’s critical for practitioners to look at the whole picture of a patient’s situation when counseling and providing advice. Multiple factors that can impact blood glucose levels and can easily be overlooked. “Principles of (diabetes) management revolve around carbohydrate awareness and counting, but also numerous other factors that alter glycemic levels. While lifestyle therapy does include food and nutrition, so does basic sleep hygiene, proper stress management, alcohol moderation, and smoking cessation. Such a comprehensive approach enhances patient care and allows individualization to improve outcomes,” said Rose.
Implementing a “Food First” Approach and The Role of Healthcare Professionals
Upon diagnosis, patients often inquire about what they can or can’t eat. Ideally, an eating plan should be a collaboration between the patient and the practitioner and tailored based on individual needs, with consideration for their cultural and economic background, lifestyle, preferences, and disease course. Given a large proportion of patients who have diabetes come from varying cultural and ethnic backgrounds, it’s imperative to consider different cultural foods and eating practices of these patients. Understanding patients’ food habits and familiar foods and showing how these familiar foods can stay in a blood-sugar-friendly diet helps to ensure compliance; patients should be able to practice their food ways and consume foods they like and are familiar with, while consuming a diet to help them improve their health and manage their diabetes. As such, managing diabetes through diet should not be a “one size fits all” approach, but there are recommendations to help us guide our patients. A Consensus Report published by Diabetes Care in the spring of 2019 provides clinical professionals with evidence-based guidance about individualizing nutrition therapy for adults with diabetes or prediabetes.6
Regardless of what food preferences or customs people have, an easy rule of thumb is to aim for half your meal to be non-starchy vegetables, one quarter to be carbohydrate foods and the remaining quarter to be protein foods. Regardless of the type of food, this thinking allows for people to still include their favorite foods while eating more of the beneficial nutrients and keeping higher carbohydrate foods in check. Considering the important role of carbohydrates in the body, people with diabetes should not be advised to follow diets that eliminate carbohydrates, however lower carbohydrate diets have been shown to be beneficial for both blood glucose management and aiding in weight loss.7
Interestingly, there is some research that food order eating can impact post-meal glucose levels as well. Research conducted at Cornell has shown consuming protein and vegetables before carbohydrates lead to lower post-meal glucose and insulin levels in obese patients with type 2 diabetes.8 The results showed that glucose levels were much lower at the 30-, 60- and 120-minute checks — by about 29%, 37% and 17%, respectively when vegetables and protein were eaten before the carbohydrates. Insulin was also significantly lower when protein and vegetables were eaten first. This finding confirms that the order in which we eat food matters, and points to a new way to effectively control post-meal glucose levels in people with diabetes.
Innovations in Diabetes Management with a Personalized Approach
Technology has made its way into nearly every aspect of our lives, and diabetes research, management and treatment are no exception. Practitioners and patients now have even more tools to assist in better understanding their biomarkers, how their body reacts to food, stress, sleep, and exercise, all to better manage diabetes.
Some of these tools include the following:
- Wearables such as Continuous Glucose Monitors: Continuous glucose monitoring (CGM) is a monitor, or small sensor-based wearable technology, which provides constant glucose readings day and night, without fingersticks. CGM allows for real-time glucose readings and feedback on glucose levels and trends to make informed diabetes management decisions. It’s been shown that CGM improves glycemic control in both type 1 and type 2 diabetes.9
- Diabetes smartphone apps: whether it’s a good thing or not, for many our phones have become extensions of our hands. Given our phones are never far away, being able to track everything from glucose readings, to meals, exercise, stress levels and beyond, helps patients manage their blood sugar, track vitals and progress, easily identify trends and share information with their HCPs, and research backs this up. Apps have been shown to positively effect outcomes, including HbA1c levels and hypoglycemia rates. Mobile health is a major and promising area of continued development for the self-management of diabetes.10
- Probiotics: The current research into gut microbiome in the field of diabetes has gradually moved step by step from the initial correlation studies, which proved a strong association, to exploring the causality and potential mechanisms. It can be foreseen that the gut microbiota will be used not only as a biomarker for diabetes, but also as a target for potential therapeutic treatments.11 One company, Pendulum Therapeutics, is already selling such products. Their research has shown that people with diabetes have low levels of Akkermansia muciniphila and other probiotic strains that help digest dietary fiber to produce butyrate, a crucial short-chain fatty acid needed for balancing glucose and supporting the gut lining. The science behind Pendulum’s main product, Pendulum Glucose Control, has demonstrated that it helps lower A1C and manage blood sugar spikes in people with Type 2 diabetes taking metformin.12
While technology is a great tool, there is no substitute for the human connection patients receive when meeting with their healthcare team for counseling and education. See below for Rose’s top recommendations when counseling patients:
3 Key Counseling Steps to Augment Adherence During Counseling Sessions
- Inform patients about shared decision-making, why it’s essential, and what to expect.
- Explain to the client that two experts are present during the clinical encounter: the patient, who is the expert on their cultural and dietary practices, and the certified diabetes educator, who provides expert guidance on food and nutrition.
- Affirm to patients or clients that their participation during the nutrition counseling session is encouraged and acceptable.
Orgain Diabetes-Friendly Products and Professional Education
Orgain offers a wide variety of diabetes-friendly nutrition products made with clean ingredients and designed to fit the changing needs of your patients and clients. With a wide variety of ready-to-drink shakes, protein powders, Orgain offers many delicious products with an impressive nutrition profile including zero or minimal added sugar, low total carbohydrates, and high protein. Orgain’s Healthcare Ambassadors can easily send Orgain product samples directly to patients through the Ambassador Sampling Portal. If you’re not a healthcare ambassador yet, request an account now and once approved, visit the Ambassador Sampling Portal to start sending samples to your patients.
Here are some of Orgain’s most popular educational resources on diabetes:
Professional Education Webinar Series
Diabetes Care & Education Update! Translating Latest Evidence-Based Guidelines Into Clinical Practice presented by Susan Weiner, MS RDN, CDCES, FADCES
The Good Clean Nutrition Podcast
Episode 19: Managing Diabetes & The Road to Better Blood Sugar Control with Kim Rose, RDN, CDCES, CNSC, LD
- Centers for Disease Control and Prevention. National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/data/statistics-report/index.html
- Centers for Disease Control and Prevention. (2022, January 24). The facts, stats, and impacts of diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html
- U.S. Department of Health and Human Services. (n.d.). Type 2 diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes
- Centers for Disease Control and Prevention. Diabetes Report Card 2021. US Dept of Health and Human Services; 2022.
- U.S. Department of Health and Human Services. Type 2 diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes
- Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., Saslow, L., Uelmen, S., Urbanski, P. B., & Yancy, W. S., Jr (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes care, 42(5), 731–754. https://doi.org/10.2337/dci19-0014
- Wheatley, S. D., Deakin, T. A., Arjomandkhah, N. C., Hollinrake, P. B., & Reeves, T. E. (2021). Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes-A Narrative Review. Frontiers in nutrition, 8, 687658.https://doi.org/10.3389/fnut.2021.687658
- Alpana P. Shukla, Radu G. Iliescu, Catherine E. Thomas, Louis J. Aronne; Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care 1 July 2015; 38 (7): e98–e99. https://doi.org/10.2337/dc15-0429
- Maria Ida Maiorino, Simona Signoriello, Antonietta Maio, Paolo Chiodini, Giuseppe Bellastella, Lorenzo Scappaticcio, Miriam Longo, Dario Giugliano, Katherine Esposito; Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Diabetes Care 1 May 2020; 43 (5): 1146–1156. https://doi.org/10.2337/dc19-1459
- Doupis, J., Festas, G., Tsilivigos, C., Efthymiou, V., & Kokkinos, A. (2020). Smartphone-Based Technology in Diabetes Management. Diabetes therapy : research, treatment and education of diabetes and related disorders, 11(3), 607–619. https://doi.org/10.1007/s13300-020-00768-3
- Li, W. Z., Stirling, K., Yang, J. J., & Zhang, L. (2020). Gut microbiota and diabetes: From correlation to causality and mechanism. World journal of diabetes, 11(7), 293–308. https://doi.org/10.4239/wjd.v11.i7.293
- Perraudeau F, McMurdie P, Bullard J, et al Improvements to postprandial glucose control in subjects with type 2 diabetes: a multicenter, double blind, randomized placebo-controlled trial of a novel probiotic formulation BMJ Open Diabetes Research Care 2020;8:e001319. doi: 10.1136/bmjdrc-2020-001319