Conversations in Motion: Optimizing Nutrition for Individuals with T2D Receiving Incretin Receptor Agonists
Learn key insights on how to optimize conversations about nutrition in people with type 2 diabetes receiving incretin therapies associated with weight lowering effects.
Date of Last Review: December 4, 2024
Conversations in Motion: Optimizing Nutrition for Individuals with T2D Receiving Incretin Receptor Agonists
19:33
Scene 1
00:00 – 00:05
[Ambient music plays in background]
CAPTION:
Conversations in Motion
KEY INSIGHTS ON OPTIMIZING NUTRITION IN PEOPLE WITH TYPE 2 DIABETES RECEIVING INCRETIN THERAPIES ASSOCIATED WITH WEIGHT LOWERING EFFECT.
Scene 2
00:00 – 00:05
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Caption:
Disclosures 2024:
Dr. Priya Jaisinghani, M.D.
Endocrinology, Obesity Medicine, Diabetes
Educational Speaking:
Eli Lilly and Company
Novo Nordisk
Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES
Dietitian, Certified Diabetes Care and Education Specialist
Educational Speaking:
Abbott Diabetes Care
Insulet
Xeris Pharmaceuticals
Scene 3
00:00 – 00:03
[Ambient music plays in background]
Caption: Lilly A Medicine company logo
00:04-05:36
Priya: Welcome to our series on optimizing nutrition in individuals with type 2 diabetes on GLP-1 and GIP/GLP-1 receptor agonists.
Hello, I'm Doctor Priya Jaisinghani, an endocrinologist.
Amy: And I'm Amy Hess Fischl, a dietitian specializing in diabetes care. We're excited to share key insights on optimizing nutrition in people with type 2 diabetes taking incretin therapies associated with weight management.
Priya: Incretin receptor agonists are important classes of medications used to treat type 2 diabetes. These therapies are based on endogenous incretin hormones and work to treat hyperglycemia through multiple mechanisms. GLP-1 RAs have been shown to increase insulin and glucagon secretion in a glucose-dependent manner, delaying gastric emptying, and reduce excess weight. The GIP/GLP-1 RAs increases insulin secretion in a glucose-dependent manner and decreases glucagon secretion in a glucose-dependent manner. It also increases insulin sensitivity, delays gastric emptying and reduces excess weight. Therapies in both classes have been shown to also modulate appetite, which is particularly advantageous for people with type 2 diabetes who have excess weight.
Amy: The benefits of lifestyle interventions including nutrition and physical activity in type 2 diabetes is widely recognized. Still, for many individuals, medications for weight loss are needed as effective adjuncts to these lifestyle interventions.
Priya: As newer therapies in these classes with high to very high efficacy in both glucose-lowering and weight management have emerged, new opportunities to optimize glucose and weight outcomes in individuals with type 2 diabetes are now available.
There are four key points we’ll emphasize today. These include:
- consuming an appropriate balance of macronutrients,
- optimizing nutrient density,
- individualizing nutrition plans, and,
- incorporating physical activity with strength or resistance training as appropriate.
Amy: Thank you so much for these helpful points. For individuals with type 2 diabetes losing or maintaining weight on incretin receptor agonists and who may have decreased appetite, it is especially important to pay attention to maintaining appropriate and balanced intake.
This entails the integration of lean proteins, high-fiber foods, and unsaturated fats while also significantly reducing intake of refined carbohydrates and sugars. Portion control and balanced macronutrient distribution are essential for optimal diabetes management. Satiety-enhancing medications should be complemented with mindful eating practices.
Now here are a few tips for people with type 2 diabetes to optimize their nutrition while taking these medications. First, integrate a greater quantity of non-starchy vegetables into their eating pattern to augment dietary fiber intake. Next, select lean protein sources such as poultry (without the skin), fish, beans, and legumes. Next choose whole grains over refined grains to promote stable glycemic management. Also minimize the consumption of added sugars and highly processed foods. Maintain adequate hydration by consuming water and abstaining from sugary beverages. And finally, carefully regulate portion sizes to prevent excessive caloric intake, even when consuming nutrient-dense foods.
Priya: These are very helpful insights! I also want to emphasize how important physical activity, including strength and resistance training, is. Synergizing a balanced nutrition plan with consistent physical exercise has the potential to amplify the therapeutic efficacy of treatment and maintain muscle mass.
It is imperative for healthcare professionals to maintain ongoing engagement with people with type 2 diabetes to stay attuned to their evolving clinical needs and to adapt treatment protocols accordingly. This approach fosters trust and ensures comprehensive support for patients throughout their therapeutic journey on GLP-1 and GIP/GLP-1 receptor agonist therapy.
Amy: So well said and also, from a nutrition standpoint, it is crucial to engage in regular discussions regarding eating and exercise habits and challenges with your patients with type 2 diabetes while also celebrating their successes.
Priya: Thank you, Amy, for sharing your knowledge with us today. In summary, in individuals with type 2 diabetes taking incretin therapies associated with weight management, there are a few key points that should be emphasized through an individualized approach. These include:
- consuming an appropriate balance of macronutrients
- optimizing nutrient density,
- individualizing nutrition plans, and,
- incorporating physical activity with strength or resistance training as appropriate.
Amy: And thank you for your insight and expertise as well Doctor Jaisinghani.
To view a video that provides comprehensive guidance on initiating discussions with your patients with type 2 diabetes in order to optimize their nutritional objectives, you may access the following link.
Caption: Conversations in Motion (Links to Scene 4)
[Ambient music plays in background]
Caption: Lilly Medicine company logo
Scene 4
00:00 – 00:04
[Ambient music plays in background; Transition into the CiM title. Subtitle animate in over time.]
CAPTION:
Conversations in Motion
OPTIMIZING NUTRITION FOR INDIVIDUALS WITH T2D RECEIVING INCRETIN RECEPTOR AGONISTS
00:05– 00:09
[Transition to the physician and person with diabetes sitting in clinic and discussing. Speech bubble appear from the physician.]
Doctor: Hi Mister James, since you have started your new type 2 diabetes medication, have you noticed any changes?
00:10– 00:17
[Speech bubble appear from the patient]
Patient: Yes, I have definitely noticed the appetite suppression that we discussed. I am eating much less than I am used to.
00:18– 00:19
[Transition to the physician and person with diabetes sitting in clinic and discussing. Speech bubble appear from the physician.]
Doctor: Can you tell me more about what you are eating?
00:20– 00:45
[Speech bubble appear from the patient]
Patient: I am moving a lot more; mostly by walking. I am working on changing my eating habits too. I discussed with the nutritionist as well; but sometimes I struggle with finding time to prepare healthier foods, so I eat out a lot. It varies from day to day. I am eating a lot less overall though; if I have half a sandwich and a cookie at lunch, I might just snack on some chips or carrots in the evening.
00:45– 00:59
[Speech bubble appear from the doctor]
Doctor: I am very happy to hear that you are getting more movement. I would like to discuss eating and nutrition in a little bit more detail.
We have previously discussed the importance of maintaining eating habits that are not too high in carbohydrates and include enough of other macronutrients.
01:00– 01:02
[Speech bubble appear from the patient]
Patient: Macronutrients? What are they?
01:03– 01:11
[Speech bubble appear from the doctor]
Dr: Macronutrients provide your body with the energy they need in the form of calories that come from carbohydrates, fat, or protein.
Are you aware of calories?
01:11– 01:24
[Speech bubble appear from the patient]
Patient: Yes, my dietitian and I discussed my individual calorie goals during weight loss, but I would like to learn more about how I can balance these macronutrients.
Could you please explain in a little more detail?
Scene 5
00:00– 00:13
[Transition to the physician and person with diabetes standing apart and a screen with the macronutrient tabs/buttons appearing on the screen in background. The screen will also have an action item ”Click on each item to view more”]
Doctor: I want to share some general recommendations for macronutrients, in people who have type 2 diabetes receiving medications with weight lowering effect. We should use these as a foundation to optimize your nutrition especially during this time when your overall appetite is lower.
Caption:
Fat
Protein
Carbohydrate
Fiber (A type of Carbohydrate)
Caption: Click on each item to view more (Clicking on each item links to Scene 5.1)
Narrator: Click on each item to view more
Scene 5.1
Caption:
Fat: 20-35% of total energy intake (~27-58 g/day)
Protein: 10-35% of total energy intake (>1.5 g/kg/day)
Carbohydrate: 45-65% of total energy intake (~135-245 g/day)
Fiber (A type of Carbohydrate):
Male: 30-38 g/day
Female: 21-25 g/day
CTA: Source of Macronutrients (Links to Scene 6)
Scene 6
00:00-00.02
[Transition to the physician and person with diabetes standing apart and a empty screen in the background. Patient asks a question to HCP]
Patient: What foods are high in these different macronutrients?
Scene 7
00:00-00.04
[Transition to the physician and person with diabetes standing apart and a screen with the macronutrient tabs/buttons appearing on thescreen in background. The screen will also have an action item ”Click on each item to view more]
Doctor: That is a great question!
I will share this list of foods that are high in these macronutrients.
Caption:
Fat
Protein
Carbohydrate
Fiber (A type of Carbohydrate)
00:05-00.07
Caption: Click on each item to view more (Clicking on each item links to Scene 7.1)
Narrator: Click on each item to view more
Scene 7.1
Caption:
Fat:
- Nuts and seeds, avocado
- Fatty fish and seafoods
- Olive, canola, and soybean oils
- Light mayonnaise
- Light salad dressing
Protein:
- Beans, peas, lentils, nuts, seeds, soy products
- Low-fat dairy foods and egg white
- Fish (fresh, frozen, or canned in water), grilled fish sticks, low-fat shellfish
- Lean meat, lean pork, such as tenderloin and loin chop
- Turkey bacon, ground chicken, or ground turkey
Carbohydrate:
- Whole grain breads, pasta, and crackers
- Soft tortillas (corn or whole wheat)
- Whole grain cereal, oatmeal, and low-fat granola
- Lower sugar crackers, such as animal graham, rye, soda, saltine, and oyster
- Pretzels (unsalted) and popcorn (unbuttered), whole-wheat pasta
- Brown or wild rice, nuts and seeds
Fiber (A type of Carbohydrate):
- Whole-grain products, oats, fruits, vegetables, beans, legumes, nuts, and seeds
CTA: Minerals (Links to Scene 8)
Scene 8
00:00-00.02
[Transition to the physician and the screen showing minerals]
Caption
- Calcium
- Copper
- Iron
- Magnesium
- Potassium
- Zinc
Doctor: Here are few important minerals that are needed in your meals
00:03-00.04
Caption: Click on each item to view more (Links to Scene 8.1)
Narrator: Click on each item to view more
Scene 8.1
Caption
Calcium
- Milk and milk products
- Green leafy vegetables
- Sardines (with bones)
- Tofu
- Beans
Copper
- Organ meats
- Seafood
- Nuts and seeds
- Whole grains
- Cocoa
Iron
- Red meat
- Fish
- Poultry
- Shellfish
- Leafy green vegetables
- Beans
- Peas
- Lentils
- Nuts
- Dried fruits
- Fortified cereals
Magnesium
- Nuts and seeds
- Beans
- Peas
- Lentils
- Dairy products
- Green leafy vegetables
- Fruits (eg, banana, avocado)
- Fish
Potassium
- Fruits
- Vegetables
- Nuts and seed
- Beans
Zinc
- Meats
- Seafood
- Poultry
- Whole grains
- Fortified cereals
- Beans
- Peas
- Lentils
- Dairy products
- Eggs
CTA: Knowledge Check! (Links to Scene 9)
Scene 9 Quiz
Caption:
What are macronutrients and why are they important for individuals with T2D?
Click on the correct answer
- Vitamins and minerals; they help in digestion
- Substances that provide energy in the form of calories from carbohydrates, fat, or protein; they help prevent rapid rises in blood sugar and keep you full for longer
- Enzymes that aid in digestion; they help in weight loss
- Hormones that regulate blood sugar levels; they help in muscle building
[Correct answer]
Congratulations!
Macronutrients are the substances that provide energy in the form of calories from carbohydrates, fat, or protein; they help prevent rapid rises in blood sugar and keep you full for longer
[Incorrect]
Incorrect. Please try again!
CTA:
- Try again (Links to Scene 9)
- Replay (Links to Scene 5)
- Continue (Links to Scene 10)
Scene 10 Quiz
Caption:
What is the recommended daily intake of fiber for males with type 2 diabetes?
Click on the correct answer
- 10-15 g/day
- 20-25 g/day
- 30-38 g/day
- 40-50 g/day
[Correct answer]
Congratulations!
The recommended daily intake of fiber for males with type 2 diabetes is 30-38 g/day.
[Incorrect]
Incorrect. Please try again!
CTA:
- Try again (Links to Scene 10)
- Replay (Links to Scene 5)
- Continue (Links to Scene 11)
Scene 11
00:00-00.10
[Transition to the physician and patient sitting in clinic and discussing. Speech bubble appear from the physician.]
Doctor: This list is an important way to highlight that not all calories are equal. The quality of the calories we consume is very important and just as quantity matters so does quality.
00:11-00.29
[Speech bubble appear from the patient.]
Patient: Thank you for highlighting that!
I have always heard about the importance of counting calories, but I did not realize that the quality of those calories mattered as well.
Can you tell me more about why “not all calories are equal” and how I can improve the choices I make when it comes to my eating habits?
00:30-00.52
[Speech bubble appear from the physician.]
Doctor: Absolutely, I'm glad you're interested in learning more!
Foods high in nutrients are considered nutrient dense. On the other hand, foods which are more processed and have more added sugars and refined grains are more likely to lack essential nutrients like fiber, protein, potassium, zinc, magnesium, and vitamins A, C, D, E, B12, and niacin.
00:53-00.55
[Speech bubble appear from the patient.]
Patient: Oh, that’s interesting!
00:56-01.02
[Speech bubble appear from the physician.]
Doctor: Yes!
For example, 100 calories of broccoli is very different from 100 calories of a processed cookie.
01.03-01.09
[Speech bubble appear from the patient.]
Patient: Great! I now kind of understand what you mean.
Could you please provide some additional tips about healthy eating habits?
01.10-01.17
[Speech bubble appear from the physician.]
[Tabs: Whole food, Non-starchy vegetables, Reduce added sugar]
Dr: Absolutely!
It is important to choose whole grains, non-starchy vegetables and reduce added sugar and refined grains in your meals.
01:18-01:20
Caption: Click on each item to view more
Narrator: Click on each item to view more
CTA:
- Whole food (Links to Scene 12)
- Non-starchy vegetables (Links to Scene 13)
- Reduce added sugar (Links to Scene 14)
Scene 12
00:00-00:09
[Ambient music plays in background]
CAPTION:
Choose whole foods over highly processed foods
- Vegetables
- Whole Grains (brown rice, quinoa, oats)
- Seeds (chia, flax, hemp seeds)
- Fruits
- Legumes (beans, lentils, peas, soy foods)
- Nuts (almonds, pecans, walnuts)
- Fresh herbs and spices
- Fortified plant milks (almond, soy, rice)
- Leafy green vegetables (broccoli, cabbage, lettuce)
CTA:
- Non-starchy vegetables (Links to Scene 13)
- Reduce added sugar (Links to Scene 14)
Scene 13
00:00-00:09
[Ambient music plays in background]
CAPTION:
Choose more non-starchy vegetables
- Broccoli
- Beans (green, wax, Italian)
- Baby corn
- Beets
- Sprouts
- Cabbage
- Cauliflower
- Celery
- Eggplant
CTA:
- Whole food (Links to Scene 12)
- Reduce added sugar (Links to Scene 14)
Scene 14
00:00-00:05
[Ambient music plays in background]
CAPTION:
Reduce added sugars and refined grains in meals
- Sugary beverages
- Desserts
- Sweet snacks
- White rice
- White breads
- Pastries and cakes
CTA:
- Whole food (Links to Scene 12)
- Non-starchy vegetables (Links to Scene 13)
- Next step: Muscle mass and physical activity (Links to Scene 15)
Scene 15
00:00-00:15
[Speech bubble appear from the physician.]
Doctor: Those are some important considerations based on nutrient density and calories.
As an important next step, I would like you to meet with our diabetes nurse educator or dietitian to specifically individualize nutrient and calorie goals for you, and to schedule a follow-up visit to reassess your goals.
00:16-00:19
[Speech bubble appear from the patient.]
Patient: Thank you, I am looking forward to this.
00:20-00:30
[Speech bubble appear from the physician.]
Doctor: There is one more key thing I would like us to discuss.
In order to help maintain muscle mass as you lose weight, it is important to consider protein intake and adding muscle strengthening or resistance exercises.
00:31-00:35
[Speech bubble appear from the patient.]
Patient: I hadn't thought about muscle mass before. Why is it so important?
00:36-00:48
[Speech bubble appear from the physician.]
Doctor: Muscle mass helps you stay strong and boosts your metabolism, which can help with weight loss and maintenance. Protein is crucial for muscle health, and exercises like lifting weights or using resistance bands can help build muscle.
00:49-00:54
[Speech bubble appear from the patient.]
Patient: That makes sense. How can I get enough protein and start these exercises?
00:55-01:17
[Speech bubble appear from the physician.]
Doctor: You can get protein from foods like lean meats, fish, eggs, dairy, beans, and nuts. Our dietitian/educator can help you find the right amount and suggest easy options for you.
From a medical perspective, I see no barriers to you starting an exercise plan. You can start with simple ones and gradually increase intensity. Our educator or a fitness trainer can guide you.
01:18-01:21
[Speech bubble appear from the patient.]
Patient: That sounds good. Thank you for the advice.
CTA: Knowledge Check! (Links to Scene 16)
Scene 16 Quiz
Caption:
What should be the focus when discussing calories with patients?
Click on the correct answer
- All calories are equal
- The quality or nutrient density of the calories consumed is important
- Almost all calories should come from protein
- Calories from processed foods are preferable
[Correct answer]
Congratulations!
The quality or nutrient density of the calories consumed is important.
[Incorrect]
Incorrect. Please try again!
[Tabs: Replay, Try again, Continue]
CTA:
- Try again (Links to Scene 16)
- Replay (Links to Scene 11)
- Continue (Links to Scene 17)
Scene 17
00:00-00:29
[Ambient music plays in background]
Caption:
‘No one size fits all – an individualized approach is a key’
Recognizing the complexity of eating behaviors, personalized approaches are essential for effective nutrition behavior change.
Consider the below questions to provide effective guidance to your patients with type 2 diabetes.
- Current Eating Patterns
- What do you eat in a typical day (for breakfast/lunch/dinner/snacks)?
- What type of beverages do you typically reach for?
- What is your monthly food budget? How often do you cook at home?
- Identify Challenges
- When do you find it challenging to eat healthfully, and why?
- What do you feel are your greatest challenges when trying to make healthy choices?
- Are there foods or beverages you would like to consume less often?
- Help Set Achievable Goals
- What is one change you can make right away?
- When/how often do you want to implement this change?
- What do you need to do to make this change between now and your next visit?
- Track The Progress
- Do you track your food intake? If so, how and when?
- Since your last visit, how have you been feeling about the change you wanted to make?
- Regarding the change you wanted to make, what has gone well since your last visit?
- Regarding the change you wanted to make, what challenges have you faced since your last visit?
Assessing the patient's preference toward changes in eating habit helps to effectively create an individualized plan
CTA: Knowledge Check! (Links to Scene 16)
Scene 18 Quiz
Caption:
What is an important consideration when setting achievable goals with patients?
Click on the correct answer
- Setting unrealistic goals
- Ignoring the patient's preferences
- Helping the patient set one change they can make right away
- Focusing only on long-term goals
[Correct answer]
Congratulations!
Helping the patient set one change they can make right away is an important consideration.
[Incorrect]
Incorrect. Please try again!
[Tabs: Replay, Try again, Continue]
CTA:
- Try again (Links to Scene 18)
- Replay (Links to Scene 17)
- Continue (Links to Scene 19)
Scene 19
00:00-00:15
[Ambient music plays in background]
Caption:
Tips for Balanced Eating
Here are some tips to share with your patients to help them improve their food choices
- Before you eat, plan your meal. Follow the plate method for a healthy, balanced meal.
- To decrease ASCVD risk factors, it is recommended to maintain food emphasizing intake of vegetables, fruits, legumes, nuts, whole grains, and fish.
- Add fruits to cereal and salads.
- Cut up veggies to snack on before meals.
- Switch to whole wheat bread, whole wheat tortillas, or brown rice for healthier grains.
- Choose grilled or baked poultry, fish, or lean meat, instead of fried, to avoid added fat.
- Find calcium in non-dairy foods, including tofu, almonds, and kale.
Scene 20
00:00-00:10
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Caption: Lilly A Medicine Company Logo
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