Table 8. American Association of Clinical Endocrinologists Healthful Eating Recommendations for Patients With Diabetes Mellitus.

Topic	Recommendation	Reference (evidence level and study design)
General eating habits	Eat regular meals and snacks; avoid fasting to lose weight Consume plant-based diet (high in fiber, low calories/glycemic index, and high in phytochemicals/antioxidants) Understand Nutrition Facts Label information Incorporate beliefs and culture into discussions Use mild cooking techniques instead of high-heat cooking Keep physician-patient discussions informal	(11 [EL 3; SS]; 12 [EL 4; position NE]; 13 [EL 4; position NE]; 14 [EL 4; review NE]; 15 [EL 3; SS]; 16 [EL 1; RCT]; 17 [EL 3; SS])
Carbohydrate	Explain the 3 types of carbohydrates—sugars, starch, and fiber—and the effects on health for each type Specify healthful carbohydrates (fresh fruits and vegetables, legumes, whole grains); target 7-10 servings per day Lower-glycemic index foods may facilitate glycemic control (glycemic index score <55 out of 100: multigrain bread, pumpernickel bread, whole oats, legumes, apple, lentils, chickpeas, mango, yams, brown rice), but there is insufficient evidence to support a formal recommendation to educate patients that sugars have both positive and negative health effects	(13 [EL 4; position NE]; 18 [EL 4; review NE]; 19 [EL 4; review NE]; 20 [EL 4; review NE]; 21 [EL 4; NE review]; 22 [EL 4; review NE]; 23 [EL 4; review NE])
Fat	Specify healthful fats (low mercury/contaminant-containing nuts, avocado, certain plant oils, fish) Limit saturated fats (butter, fatty red meats, tropical plant oils, fast foods) and trans fat; choose fat-free or low-fat dairy products	(24 [EL 4; review NE]; 25 [EL 4; review NE]; 26 [EL 4; NE review])
Protein	Consume protein in foods with low saturated fats (fish, egg whites, beans); there is no need to avoid animal protein Avoid or limit processed meats	(13 [EL 4; position NE]; 27 [EL 2; MNRCT]; 28 [EL 2; PCS, data may not be generalizable to patients with diabetes already])
Micronutrients	Routine supplementation is not necessary; a healthful eating meal plan can generally provide sufficient micronutrients Specifically, chromium; vanadium; magnesium; vitamins A, C, and E; and CoQ10 are not recommended for glycemic control Vitamin supplements should be recommended to patients at risk of insufficiency or deficiency	(29 [EL 4; CPG NE])

Abbreviations: BEL = best evidence level; CPG = clinical practice guideline; EL = evidence level; MNRCT = meta-analysis of non-randomized prospective or case-controlled trials; NE = no evidence (theory, opinion, consensus, review, or preclinical study); PCS = prospective cohort study; RCT = randomized controlled trial.