Salvia Meg G, Quatromoni Paula A
Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Am J Med Open. 2023 Jan 28;9:100034. doi: 10.1016/j.ajmo.2023.100034. eCollection 2023 Jun.
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.
营养干预是2型糖尿病管理的关键组成部分；在饮食模式上做出有利于健康的改变可以改善餐后血糖波动，并降低糖化血红蛋白（HbA1c）水平，以减少糖尿病相关的发病率和死亡率。关于实施热量限制和/或低碳水化合物饮食的研究很多，不过能否将生理和行为改变维持超过12个月仍是一个问题。需要了解干预目标和依从性，以便将这项研究应用于患者护理，并将期望转化为现实生活情境。包括地中海饮食模式、素食或纯素饮食模式，或其他强调优质碳水化合物（如全谷物）、蔬菜、完整水果、豆类和鱼类的饮食模式，都有助于实现血糖目标。像动机性访谈这样的咨询策略可用于培养饮食能力。这些方法将协作决策放在首位，目标是增强患者的自主权和自我效能感。文中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，并给予适当支持以应对实施和维持行为改变过程中的挑战，这是很有必要的。此外，健康的社会决定因素，包括环境背景、教育、社会经济地位、获得医疗保健的机会以及系统性耻辱感（如种族主义或体重偏见）的经历，可能会干扰个人糖尿病自我护理和营养行为。提供医学营养治疗并根据个人需求和情况调整营养干预措施，可能是医生、营养师和糖尿病护理人员支持2型糖尿病患者的重要方式。
