Preparing to Prescribe Plant-Based Diets for Diabetes Prevention and Treatment

The number of people worldwide with type 2 diabetes is expected to double by 2030.1 In the United States, diabetes affects ~ 26 million people of all ages, about one-fourth of whom are not yet diagnosed.2 Despite the availability of a wide range of pharmacological treatments and the best efforts of diabetes educators and other health care professionals, good control of diabetes and its comorbidities remains elusive for much of the population, as evidenced by rates of cardiovascular morbidity and mortality that are two to four times higher than those of people who do not have diabetes.2 Although dietary habits and body weight play undisputed roles in type 2 diabetes, the question of what eating pattern best addresses glycemia, cardiovascular risk factors, and weight control remains controversial. The uniform, caloriecontrolled diabetic diet plans of the past have been replaced by individualized meal-planning approaches, and in more recent years, nutrition guidance has focused on carbohydrate counting and minimizing saturated and trans fats. With the release of the U.S. Department of Agriculture’s 2010 Dietary Guidelines for Americans3 came praise for plant-based eating patterns, which have been extensively studied for weight management and disease prevention and treatment. Individuals following a plantbased eating pattern typically consume fewer calories and less fat, saturated fat, and cholesterol and have lower BMIs than nonvegetarians. They also consume more fiber, potassium, and vitamin C. In prospective studies of adults, compared to nonvegetarian eating patterns, vegetarian eating patterns have been associated with lower prevalence rates of type 2 diabetes,4 cardiovascular disease (CVD),5 hypertension,6 and obesity7,8 and reduced medical care usage.9 Both the American Academy of Nutrition and Dietetics and the American Diabetes Association (ADA) now include well-planned, plant-based eating patterns (vegetarian and vegan) as a meal-planning option in their nutrition recommendations for people with diabetes.10,11 This article provides a brief discussion of research on plant-based eating patterns, relevant nutrition issues, and practical applications for clinicians.