For adults with type 2 diabetes who are overweight or obese, reducing energy intake while retaining a healthy and nutrient-adequate eating pattern is recommended. Even a moderate amount of weight loss may improve glycemia, blood pressure, and blood lipids, especially among those in the early stage of the diabetic disease process. To achieve a reasonable amount of weight loss, MNT, physical activity, and/or behavior change is encouraged [11]. As evidence suggests there is not a single dietary plan that is appropriate for all people with diabetes, the distribution of dietary macronutrients as well as micronutrients should be based on an individualized assessment of food preferences, eating patterns, and metabolic goals [12]. The Dietary Reference Intakes (DRIs) [13] – which include recommended dietary allowances (RDAs) , adequate intakes (AIs) , estimated safe and adequate daily dietary intakes (ESADDIs) , and tolerable upper intake levels (ULs) (see Appendix 5 for a description and table of DRIs) – provide a general framework from which to individualize each patient’s nutritional goals. According to the DRIs , the acceptable macronutrient distribution range for adults is 45–65% of total energy needs from carbohydrates, 10–35% from protein, and 20–35% from fat. Note that the wide ranges for each of these macronutrients include those that are recommended for patients with diabetes, underscoring the need for individualized dietary recommendations .

Both quantity and type of carbohydrate influence blood glucose levels . The total amount of carbohydrate eaten is the primary predictor of glycemic response. Monitoring carbohydrate amounts is thus a useful strategy for improving postprandial glucose control. Carbohydrates from fruits, whole grains, legumes, vegetables, and dairy are recommended. Other sources of carbohydrates, such as those with added sodium, sugar, and fats, are not recommended or, if consumed, recommended in lower amounts [10, 12]. Common lore suggests that patients with diabetes should limit their intake of carbohydrates. Indeed, many patients erroneously believe they should eliminate fruits and/or starchy vegetables from their diets. But without adequate carbohydrate intake, protein is used for energy as opposed to being used to synthesize new proteins critical for maintaining homeostasis and immune function. Thus, complete avoidance of these foods may compromise the nutritional quality of the diet and overall health. Instead of eliminating, strategies for good glucose control include the distribution of carbohydrates throughout the day, consuming carbohydrate-rich foods with meals, and avoiding concentrated carbohydrate doses. A variety of methods for diabetes meal planning are presented to patients by RDNs or diabetes educators and include the plate method, carbohydrate counting, and glycemic index [13]. Fiber, which can reduce the impact of food-derived glucose on blood glucose, is recommended in the same amounts as for the general population. Fiber is nondigestible and therefore provides little to no energy. Patients with diabetes should aim for about 25 (adult women) and 38 (adult men) grams of fiber daily. This amounts to approximately 14 g of fiber/1,000 kcals/day [14].

The amount of protein intake required to optimize glycemic control among those with diabetes is controversial, but all experts agree that protein intake goals should be individualized within the DRI ranges [14]. People with diabetes, including those with diabetic kidney disease, should not reduce their dietary protein intake unless it is specifically advised; doing so could alter glycemic control and negatively impact kidney function, cardiovascular risk, and bone status [15]. Meats of all kinds, fish, poultry, cheeses, and lower-fat dairy foods, eggs, and some plant-based foods are all good sources of high biological value protein and should be encouraged in moderation .