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Diabetes Editorial Improving Diabetes Outcomes through Nutrition and Lifestyle Change— Translating Research to Practice Linda M Delahanty, MS, RDN Assistant Professor of Medicine, Harvard Medical School; Chief Dietitian and Director of Nutrition and Behavioral Research, Diabetes Center, Boston, Massachusetts, US Abstract The evidence supporting effectiveness of nutrition and lifestyle change in improving diabetes-related outcomes is substantial. The process of translating that evidence into practice in ways that are tailored to each patient’s clinical profile, eating habits and lifestyle, and learning style needs team collaboration including referral to lifestyle programs or registered dietitians for medical nutrition therapy. Patients need to receive consistent messaging about nutrition and lifestyle priorities and be engaged in collaborating on doable action steps that build self-efficacy and improve outcomes. Keywords Nutrition, lifestyle change, diabetes outcomes, self-management Disclosure: Linda M Delahanty, MS, RDN, is a member of the Advisory Board for Omada Health and is a consultant to JanaCare. No funding was received for the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: July 17, 2015 Published Online: October 24, 2015 Citation: US Endocrinology, 2015;11(2):77–8 Correspondence: Linda M Delahanty, MS, RDN, Diabetes Center, Massachusetts General Hospital, 50 Staniford St Suite 340, Boston, MA 02114, US. E: ldelahanty@partners.org Managing diabetes from a provider perspective has to do with how well a patient does with what we refer to as the ABCs (A1c, blood pressure, and cholesterol) of diabetes control. To reduce risk for diabetes complications, patients and providers discuss achieving an A1c level of about 7%; a blood pressure of <140/90 mmHg; and a cholesterol profile of low-density lipoprotein (LDL) <100 mg/dl if there is no overt cardiovascular disease (CVD) and an LDL of <70 mg/dl if there is overt CVD, with high-density lipoprotein >40 mg/dl for men and >50 mg/dl for women, and triglycerides <150 mg/dl through a combination of nutrition, lifestyle, and medication. 1,2 The cumulative potential LDL lowering that can be achieved with dietary modification is estimated to be 20–30% based on achieving the following goals: reducing saturated fat intake to <7% of calories, reducing cholesterol intake to <200 mg/day, losing 10 pounds, and including 5–10 g viscous fiber and 2 g plant sterol/stanol esters per day. 3 The Joint National Committee report on dietary components that can reduce blood pressure estimates a cumulative potential systolic blood pressure lowering of 19–50 mmHg based on an ability to lose 10 kg of body weight, follow a Dietary Approaches to Stop Hypertension (DASH) eating plan, reduce sodium intake to <2,400 mg/ day, limit alcohol consumption to <2 drinks per day for men and <1 drink per day for women, and achieve 30 minutes per day of aerobic activity. 4 To achieve A1c targets for management of prediabetes and type 2 diabetes, the nutrition and lifestyle recommendations of achieving a 7% weight loss and achieving at least 150 minutes of physical activity per week are TOU CH MED ICA L MEDIA largely based on the evidence from Diabetes Prevention Program and the Look AHEAD trial. 1,5–7 The American Diabetes Association’s nutrition recommendations also include reducing saturated fat intake to <10% of calories, minimizing trans fat intake, moderation in alcohol consumption, and limiting or avoiding sugar-sweetened beverages to reduce risk for weight gain and worsening of cardiometabolic profile for both type 1 and type 2 diabetes. 2 For type 1 diabetes, the evidence for achieving glycemic targets is more focused on maintaining consistent carbohydrate intake for patients on fixed insulin regimens and on adjusting insulin to carbohydrate intake for those on flexible insulin regimens. 2 Also, in the context of intensive therapy within the Diabetes Control and Complications trial, there is evidence that six specific diet behaviors are each associated with a 0.25–1 point lower A1c: adhering to diet (consistency in diet), adjusting insulin for variations in food intake, promptly treating hyperglycemia in terms of more insulin or less food, avoiding overtreatment of hypoglycemia, avoiding extra snacks, and achieving consistency in night-time snacks. 8 So, with all of these evidence-based recommendations, what advice is a provider to give when a patient asks, “What should I eat?” It is not unusual that one provider might tell a patient to focus on carbohydrate intake, another to focus on calorie and fat intake, and yet another on sodium intake. The information on the Internet brings the same confusion. We also have evidence that the US population is falling short of meeting healthy-diet behavior goals that are associated with reduced risk for heart disease and stroke, another goal of diabetes management. Even 77