Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

Abstract

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.

Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial

“…The tDNA template was adapted for a Malaysian application, taking into account cultural differences in lifestyle, including healthy eating patterns, and genetic factors. 12 The Malaysian tDNA recommends MNT as an integral component of glycemic control in type 2 diabetes. Patients should receive personalized nutrition counseling from dietitians, targeting weight loss of 5%–10% in 6 months, use of meal replacements to reduce total calorie intake, increased physical activity, and enhanced support to motivate patients so they can adhere with MNT recommendations.…”

Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial

“…Patients were randomized to receive usual diabetes care (UC) or a structured lifestyle intervention based on the Malaysian tDNA [ 7 ]. Patients in the tDNA group were further randomized to receive either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC) techniques to improve adherence to the lifestyle recommendations.…”

“…To enable the broad implementation of these recommendations, the international task force of diabetes and nutrition experts developed the global trans-cultural diabetes nutrition algorithm (tDNA) to facilitate the delivery of nutrition therapy to patients with T2D and prediabetes in a variety of cultures, ethnic and geographic locations [ 6 ]. The global tDNA was later adapted for the Malaysian application in view of our unique disease characteristics, risk factors, cultural and lifestyle dissimilarities [ 7 ]. We recently published the effectiveness of a structured lifestyle intervention based on the tDNA, delivered using validated behavioral approaches such as the motivational interviewing (MI) and conventional counseling (CC) on weight and hemoglobin A1C (A1C) changes in patients with T2D and overweight/obesity [ 8 ].…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…The results of novel international summits from 2010 to 2013 (110)(111)(112)(113)(114)(115)(116)(117), led by U.S. tDNA committee members and local thought leaders, were curated and then incorpo- rated into a tangible toolkit with multiple formats to facilitate local HCP-patient encounters (118). Content validation by diabetes specialists and primary care HCP was reported in 2014 (118).…”