Texas Health Harris Methodist Hurst-Euless-Bedford

1600 Hospital Pkwy

Bedford, TX 76022

Date: June 27, 2019

To: Natasha Trace Robinson, MSN
Nurse Practitioner
Texas Health Harris Methodist
From: Kyle McGinn, RN
Texas Health Harris Methodist
Subject: Recommending Plant-based Diets for Treating Type 2 Diabetes

Purpose

This is a report to recommend plant-based diets as an alternative treatment option across all care

for pre-diabetes and those diagnosed with type 2 diabetes.

Summary

“Type 2 diabetes is a global epidemic, with approximately 422 million cases worldwide and a

rapidly rising prevalence in middle- and low-income countries” (McMacken and Shah 342).

Twelve to 14 percent of adults in the United States had T2DM in 2011-2012 and prediabetes was

prevalent in 38 percent. Diabetic adults have “annual per capita costs of $7,900,” which is 2.3

times more than the costs for non-diabetic adults (342).

It’s estimated that the total number of cases will “reach 552 million by 2030.” The growth of

T2DM is impacting health care costs as treatment is approximating $490 billion (Lee et al 1).

These are major concerns to consider and are creating a need to discover more effective and

affordable medications. Preventing this disease, “especially in those individuals with

prediabetes, hinges on diet and exercise” (Huether and McCance).

According to McMacken and Shah: “Large healthcare organizations such as Kaiser Permanente

are promoting plant-based diets for all of their patients because it is a cost-effective, low-risk

intervention that treats numerous chronic illnesses simultaneously and is seen as an important

tool to address the rising cost of healthcare.”

Making lifestyle interventions – such as diet - often leads to the most success in “preventing,

treating, and even reversing type 2 diabetes” (McMacken and Shah 342). Studies indicate that

dietary changes – such as plant-based diets - are becoming effective methods for preventing and

managing T2DM.

Introduction

Plant-based diets abstain from most - if not all - animal products. They focus on consuming

vegetables, whole grains, fruits, nuts, seeds, and legumes. McMacken and Shah assert that plant-

based diets have also been “associated with much lower rates of obesity, hypertension

hyperlipidemia, cardiovascular mortality, and cancer.”

In the “diabetic population,” cardiovascular disease (CVD) is a “major” cause of “premature

mortality.” Many studies demonstrate the benefits of plant-based diets in preventing and treating

CVD. Compared to “omnivorous” diets, vegetarianism has been attributed to reducing ischemic

heart disease incidence and death by 24 to 32 percent (McMacken and Shah 345).

In the “landmark Diabetes Prevention Program,” “older adults” experienced the most benefits

from making lifestyle adjustments. In the group ages ≥60, lifestyle changes resulted in a “71%

reduction” in the risk of T2DM (McMacken and Shah 342).

Also, information from a 2009 study on various diets concluded that the consumption of animal

products can lead to a greater “diabetes prevalence.” The results ranged from “2.9% in vegans”

to “7.8%” in the animal product consumption group (Trapp and Levin 38).

Furthermore, plant-based diets can benefit T2DM patients by reducing insulin resistance. Whole

plant foods that are “minimally processed” include nutrients that “promote insulin sensitivity”

(McMacken and Shah 348). These include antioxidants, fiber, and magnesium. McMacken and

Shah conclude that “fiber reduces the energy density of foods, promotes satiety, and has been

associated with weight loss, which in turn reduces insulin resistance.”

Recommendation

There is extensive existing research, teaching us that vegetarians can have a lower prevalence of

diabetes than non-vegetarians. According to Trapp and Levin: “plant-based eating patterns

combined with exercise have been found to improve diabetes control and reduce the need for

medication in intervention trials as far back as 1976.”

Based on positive results from extensive research being conducted, I recommend integrating the

plant-based diet to patients as a cost-saving, alternative plan of care for pre-diabetes and those

diagnosed with T2DM. The integration of this recommendation will be divided into two

categories: Task 1 and Task 2.

Practical Application

Task 1 involves evaluation. It's imperative for the nurse to evaluate their patient’s current eating

habits prior to implementation of the diet.

First, the nurse will inform the patient about current research and the health-related benefits

experienced by people who have either reduced or eliminated their animal product consumption.

If applicable, the nurse can then share stories of any former patients who have improved their

diabetes symptoms by following a plant-based diet. The nurse can finally ask if the patient is

interested in learning more about a plant-based diet (Trapp and Levin 40).

Task 2 consists of implementing the diet through education. The nurse can provide the patient

with “visual aids” and “handouts” of information and available online resources. For example,

www.thepowerplate.org explains the plant-based food groups of grains, legumes, fruits, and

vegetables. Additional websites offer ideas for vegan meals, snacks, recipes, and they provide

“scientific evidence” to explain the effectiveness of the diet. They also include possible “grocery

lists” and “sample menus.” Other online resources are available for helping people “get started”

and “kick off” their plant-based journey (Trapp and Levin).

Conclusion

With rapid increases in prevalence and healthcare costs associated with T2DM, it is necessary to

find safe and cost-effective alternatives for our patients. There is strong evidence to support

whole-foods plant-based diets as highly beneficial for preventing and treating type 2 diabetes. I

recommend integrating this diet into our practice through two tasks, which include diet

assessment and education.

While some patients may be unwilling to adhere to a whole-foods regimen, McMacken and Shah

suggest that “a plant-based diet has been shown to be similarly acceptable to an ADA diet among

people with diabetes” (349).

 Works Cited
McMacken, Michelle, and Sapana Shah. “A Plant-Based Diet for the Prevention and

Treatment of Type 2 Diabetes.” Journal of Geriatric Cardiology, vol. 14, no. 5,

Jan. 2015, pp. 342-354. doi:10.11909/j.issn.1671-5411.2017.05.009

Lee, Vincent, Taylor McKay, and Chris I., Ardern. “Awareness and Perception of Plant-

Based Diets for the Treatment and Management of Type 2 Diabetes in a

Community Education Clinic: A Pilot Study.” Journal of Nutrition and

Metabolism, vol. 2015, Feb. 2012, pp. 1-6. doi:

http://dx.doi.org/10.1155/2015/236234

Huether, Sue E., and Kathryn L. McCance. Understanding pathophysiology (6th ed).

Elsevier Inc, 2017

Trapp, Caroline, and Susan Levin. “Preparing to Prescribe Plant-Based Diets for Diabetes

Prevention and Treatment.” Diabetes Spectrum, vol. 25, no. 1, Feb. 2012, pp. 38-

44. doi: https://doi.org/10.2337/diaspect.25.1.38