Transculturalization of a Diabetes-Specific Nutrition Algorithm: Asian Application

Abstract

The prevalence of type 2 diabetes (T2D) in Asia is growing at an alarming rate, posing significant clinical and economic risk to health care stakeholders. Commonly, Asian patients with T2D manifest a distinctive combination of characteristics that include earlier disease onset, distinct pathophysiology, syndrome of complications, and shorter life expectancy. Optimizing treatment outcomes for such patients requires a coordinated inclusive care plan and knowledgeable practitioners. Comprehensive management starts with medical nutrition therapy (MNT) in a broader lifestyle modification program. Implementing diabetes-specific MNT in Asia requires high-quality and transparent clinical practice guidelines (CPGs) that are regionally adapted for cultural, ethnic, and socioeconomic factors. Respected CPGs for nutrition and diabetes therapy are available from prestigious medical societies. For cost efficiency and effectiveness, health care authorities can select these CPGs for Asian implementation following abridgement and cultural adaptation that includes: defining nutrition therapy in meaningful ways, selecting lower cutoff values for healthy body mass indices and waist circumferences (WCs), identifying the dietary composition of MNT based on regional availability and preference, and expanding nutrition therapy for concomitant hypertension, dyslipidemia, overweight/obesity, and chronic kidney disease. An international task force of respected health care professionals has contributed to this process. To date, task force members have selected appropriate evidence-based CPGs and simplified them into an algorithm for diabetes-specific nutrition therapy. Following cultural adaptation, Asian and Asian-Indian versions of this algorithmic tool have emerged. The Asian version is presented in this report.

Impact of diet on the efficacy of insulin lispro mix 25 and insulin lispro mix 50 as starter insulin in East Asian patients with type 2 diabetes: Subgroup analysis of the Comparison Between Low Mixed Insulin and Mid Mixed Insulin as Starter Insulin For Patients with Type 2 Diabetes Mellitus (CLASSIFY Study) randomized trial

“…Studies have shown that traditional Asian diets include a larger proportion of carbohydrates (55-70% total energy intake) and a smaller proportion of fat compared with typical Western diets 23 . The carbohydrate component of the diets of the participants in the present study (mean 54% daily energy intake) is consistent with a traditional Asian diet, and is well within the limits (<55-65% daily energy intake) recommended for patients with diabetes in China 24 . This is in contrast to the findings from a previous study, which suggested that most newly diagnosed (less than 3 months) patients with type 2 diabetes mellitus in China consumed a much larger proportion (67% of energy intake) of carbohydrates in their diet 11 .…”

Glycemia Targeted Specialized Nutrition (GTSN) improves postprandial glycemia and GLP-1 with similar appetitive responses compared to a healthful whole food breakfast in persons with type 2 diabetes: a randomized, controlled trial

“…However, diabetes dietary guidelines can be cumbersome. Due to their ease of use and previously discussed efficacy, meal or calorie replacements that are also glycemia-targeted have been incorporated as a recommended tool in several diabetesspecific nutritional plans [33,34] and within the recently published Transcultural Diabetes-specific Nutritional Algorithms [4][5][6]. This study demonstrates that breakfast consumption in people with T2DM can be metabolically beneficial when appropriate glycemia-targeted breakfast choices are made and supports the use of GTSN at the breakfast eating occasion as recommended in the Transcultural Diabetes-specific Nutrition Algorithms [4][5][6].…”

“…Medical nutrition therapy is a critical part of globally accepted treatment guidelines for type 2 diabetes mellitus (T2DM) [1][2][3][4][5][6]. An important feature of these nutrition therapeutic guidelines is attention to type and amount of carbohydrate and calorie control leading to weight management.…”

“…Glycemia Targeted Specialized Nutrition (GTSN) such as the meal replacements utilized in the LookAHEAD [7,8] and Sun et al [9], trials have been included as an integral part of a recently published Transcultural Nutrition Algorithm that advocates lifestyle modification as an adjunct to pharmacotherapy [4][5][6]. GTSN formulas containing low glycemic index and slowly digested carbohydrates were shown to exert better glycemic management as compared to standard formulas [9,[14][15][16][17][18][19] when used as a meal or calorie replacement or as a dietary supplement as part of overall nutritional management of diabetes [reviewed in 16].…”

The Transcultural Diabetes Nutrition Algorithm

“…The tDNA-PATh toolkit (Figure 22.1) has been validated for content, clinical needs, and utility via survey methodology [31,43,45,47]. This phase includes an in-office toolkit, which is referred to as "tDNA-Patient Algorithm Therapy" (tDNA-PATh), and is the result of a collaborative effort between the tDNA-CIC and Joslin Diabetes Center health services.…”