Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

Table 3

Glycemia-targeted specialized nutrition (GTSN) for the management of prediabetes and type 2 diabetes.

Overweight (BMI > 23 kg/m^2) or obese (BMI > 27.5 kg/m^2)		Use meal and/or snack replacements^a as part of a meal plan to reduce total calorie intake; (i) Calorie reduction of 500–1000 calories per day (to lose 0.5–1.0 kg per week), using 1-2 servings of a GTSN formula^b to replace 250–500 calories from meals; (ii) Reassess every 1–3 months
Normal weight (BMI 18–23 kg/m^2)	Controlled diabetes (A1c ≤ 6.5%^c)	The use of meal replacements should be based on clinical judgment and individual assessment^d
	Uncontrolled diabetes (A1c > 6.5%^c)	Use 1-2 servings of a GTSN formula per day to be incorporated into a meal plan
Underweight (BMI < 18 kg/m^2)		Use 1–3 servings of a GTSN formula per day as supplementation based on clinical judgment and individual assessment of desired rate of weight gain and clinical tolerance

BMI: body mass index; A1c: glycosylated hemoglobin; GTSN: glycemia-targeted specialized nutrition.
Recommendations were rated and assigned numerical and alphabetical descriptors according to levels of scientific substantiation provided by the 2010 American Association of Clinical Endocrinologists protocol for the development of Clinical Practice Guidelines [27].
^aMeal and snack replacements are nutritional products used as replacement for meals or snacks to replace calories in the diet. It is suggested that products used should meet the American Diabetes Association nutritional guidelines.
^bGlycemia-targeted specialized nutrition formulas are complete and balanced products with at least 200 calories per serving used as part of a meal plan to help control calorie intake and achieve glycemic control.
^cGlycemic (A1c) targets should be individualized for each patient based on local CPGs.
^dTo avoid hypoglycemia or postprandial hyperglycemia, individuals who may have muscle mass and/or function loss and/or micronutrient deficiency may benefit from a nutrition supplement. Individuals who need support with weight maintenance and/or a healthy meal plan could benefit from meal replacement.