Bridging Science and Reality in Diabetes Care

Nutrition science is evolving, and so is the responsibility of clinicians to translate that science into meaningful care. During the panel discussion, “From Evidence to the Plate: What the New Nutrition Guidelines Mean for Diabetes Care,” at the American Diabetes Association 2026 Scientific Sessions, leading experts spanning dietary policy, diabetes nutrition, obesity medicine, and implementation science converged on a shared message.

Evidence alone is not enough. Guidelines must be individualized, culturally responsive, and grounded in research that reflects the populations they aim to serve. From protein prioritization to the role of GLP-1 medications, conversations revealed both the progress made and the gaps that remain for a broader reckoning with how chronic disease, obesity, and diabetes intersect and that one-size-fits-all recommendations are no longer applicable or feasible.

Here is what each panelist had to say and what this means for practice.

The Guidelines Gap: When Science Meets Policy¹

Christopher Taylor, PhD, RDN, LD, FAND, offered attendees a rare inside view of the dietary guidelines process, drawing on his experience serving on the 2025 Dietary Guidelines Advisory Committee (DGAC) and chairing its Food Pattern Modeling Subcommittee. From the Ohio State University School of Health and Rehabilitation Sciences, Taylor walked through the 5-step process he and the committee followed when compiling their scientific evidence base: scientific questions are established, committee members are vetted, evidence is reviewed, a scientific report is produced, and that report is handed to HHS, at which point the committee’s role ends.

“We got appointed, we wrote a report, and we were done,” he said plainly, explaining that their evidence is then used to inform the dietary guidelines, which then get implemented.

Central to the committee’s work was food pattern modeling, better understood as testing what happens to nutrient adequacy when dietary patterns shift. When the committee modeled reductions in refined grains, folate and iron gaps emerged, particularly in adolescent females and women of childbearing age. This finding illustrated a critical tension: what the evidence supports for chronic disease outcomes does not always translate neatly into nutritionally adequate public guidance.

The committee also found strong data supporting fruits, vegetables, whole grains, legumes, nuts, and seeds. Evidence on ultraprocessed foods, however, remained too limited for strong recommendations. On saturated fat, the data pointed to food source specificity: replacing animal sources with plant sources reduced cardiovascular risk; replacing them with refined carbohydrates did not.

Taylor also drew pointed comparisons between the DGAC’s work and the guidelines ultimately released. The final document was developed by a separate group of paid experts over 3 months, without public meetings or a comment period, a stark contrast to the committee’s 2-year, volunteer-driven, publicly transparent process.

The new guidelines preserve the core dietary framework: nutrient-dense foods, whole grains, fruits, vegetables, dairy, and varied protein sources remain central, with continued limits on added sugars, sodium, and saturated fat. But the messaging has shifted toward a stronger emphasis on protein and a specific recommendation to reduce alcohol. Familiar vegetable subgroup distributions were eliminated, streamlining guidance but reducing specificity.

Of the 56 recommendations the committee put forward, only 14 were fully accepted and 12 partially implemented. For diabetes care providers, Taylor’s session was a call to read the guidelines critically, understanding not just what they say, but how they were shaped, and what the science behind them truly supports.

One Size Does Not Fit All Populations²

Rising rates of chronic disease despite decades of dietary guidelines might seem like evidence that the guidelines aren’t working, a conclusion that Hollie Raynor, PhD, RD, LD, member of the 2025 DGAC and executive associate dean of research and operations, University of Tennessee College of Education, Health, and Human Sciences, pushed back on before redirecting the conversation toward a more fundamental problem. The guidelines may not be reaching the right people, because the research behind them doesn’t always reflect them.

Precision nutrition, Raynor noted, is not just a biomedical concept. It is also a social one.

Raynor opened with a sobering data point: since 2005, the US Healthy Eating Index has consistently hovered between average scores of 55 and 60. Before declaring the guidelines ineffective, she argued, the question to ask is, “Were they ever truly implemented?”

“We have data that’s suggesting that we are not implementing the guidelines well and we’re not seeing a change in the prevalence of chronic disease,” she said. “This would actually indicate we’re not learning very much from this process.”

Bring implementation science into the guidelines framework, she proposed. Implementation science examines why an intervention does or doesn’t take hold in practice by identifying barriers, facilitators, and the adaptations needed for different populations and settings. Raynor focused specifically on generalizability. She illustrated how averages in studies can mask wide individual variation, reflecting the urgent need for diverse, representative research samples. Because if the studies informing population-based guidelines don’t reflect the population, she emphasized, the resulting recommendations won’t either.

Across multiple bodies of evidence, she and her team have repeatedly encountered research bases with limited racial, ethnic, and socioeconomic diversity; in some cases, they have found studies to not report demographic data at all. Household food insecurity, a variable with clear implications for nutrition outcomes, is rarely captured unless it is the primary research question.

Her call to action was clear and directed at 3 audiences:

• Guideline developers should weight generalizability more heavily in their grading processes
• Practitioners should interrogate whether the research behind their recommendations reflects their patient population
• Researchers should prioritize measuring and reporting the variables that shape how individuals actually respond to dietary guidance, including socioeconomic position

The 2026 ADA Nutrition Guidance Update³

When patients with diabetes ask what they should be eating, where should clinicians turn for answers? Holly Willis, PhD, RDN, LD, CDCES, certified diabetes care and education specialist at International Diabetes Center, made the case that 2026 brought a wealth of updated, practice-ready resources.

Willis pointed care providers to 3 core references: Chapter 5 of the ADA Standards of Care in Diabetes, the newly released fourth edition of the ADA Nutrition Therapy report, and the forthcoming updated consensus report on nutrition therapy for adults with diabetes and prediabetes. Some messages, she emphasized, haven’t changed. There is still no one-size-fits-all approach, many eating patterns can work, and medical nutrition therapy delivered by a registered dietitian remains essential, with evidence showing it can reduce hemoglobin A_1C by 1% to 2%.

What has changed is the overall framing. The 2026 guidance moves decisively away from calories and macronutrients toward a food-quality, food-forward approach. “People eat foods, they don’t eat nutrients, and macronutrients are interchangeable,” Willis said. “Coca-Cola and strawberries, yes, both are carbohydrates, but clearly that is not the same food.”

The guidance on carbohydrate reduction now carries an important qualifier: the benefit is most likely to come from reducing processed foods specifically, not carbohydrates broadly. Plant-based language has also expanded, now encompassing nuts, cheese, and legumes rather than implying vegetarian or vegan eating patterns exclusively. Weight loss targets have shifted upward, with a minimum of 5% now recommended, and with stronger language supporting medication use to augment, not replace, lifestyle modifications.

New this year are tools to calculate fasting risk scores for patients with diabetes who choose to fast for religious or other reasons, and updated guidance on using continuous glucose monitors and other technology to help patients connect food choices to real-time outcomes.

Willis closed with a practical framework for all providers, echoing sentiments put forth by Raynor: embrace the no-one-size-fits-all principle, keep the focus on food quality over dietary orthodoxy, and use a data-informed, patient-centered approach. For non-dietitians in the room, her message was clear. The resources are valuable, but the referral is where the real work happens.

Obesity Care Strategies for a Primary Care Framework⁴

Victoria Bouhairie, MD, DABCOM, DipABLM, who brought the conversation out of the research realm and into the exam room, framed her presentation around a single, practical question: what can a primary care provider realistically accomplish in 15 minutes with a patient living with overweight or obesity? Bouhairie is senior vice president, obesity care and prevention, American Diabetes Association.

Her answer began not with food, but with language. Bias against patients with obesity is well-documented and directly affects outcomes. Person-first communication is not a courtesy, it is a clinical tool that shapes outcome, she argued. When patients feel seen and respected, shared decision-making becomes possible, and with it, genuine partnership.

“We’re here to support them,” Bouhairie said, “so having that shared approach where you’re giving them the knowledge and giving them the ability to also help make these decisions and goals really helps.”

That patient-centered philosophy extended to her discussion of social determinants of health. Citing the newly released ADA Standards of Care mentioned by Willis, Bouhairie urged providers to know the full context of each patient’s life: their cultural background, health literacy, financial constraints, and food access. Screening for food insecurity, she noted, is a critical but often overlooked step in nutrition assessment. Bouhairie recommended meeting patients where they are. She also highlighted the Diabetes Self-Management Education and Support program as an underutilized resource that has demonstrated meaningful weight loss outcomes alongside its diabetes management benefits. This program is one covered by Medicare and many commercial and Medicaid plans.

On nutrition assessment, Bouhairie walked through the tradeoffs of 24-hour recalls, food frequency questionnaires, and 3-day intake records, noting the inherent biases of each and the importance of using them alongside an understanding of the patient’s real-world context. For patients on obesity medications or who have undergone bariatric surgery, she flagged a critical nutritional concern: 25% to 30% of weight lost on these therapies comes from lean muscle mass. Providers should prioritize protein optimization, resistance exercise, increased fiber and water intake, and monitoring for micronutrient deficiencies. She closed with her 6 A’s framework—Ask, Assess, Advise, Agree, Assist, Arrange—as a practical scaffold for 15-minute encounters.

The throughline of her session was clear: effective obesity care in primary care is not about having all the answers. It is about asking the right questions, knowing your resources, and making sure the care you offer genuinely applies to the person sitting in front of you.

References

1. Taylor C. The 2025-2030 Dietary Guidelines for Americans: overview and challenges. Presented at: American Diabetes Association 2026 Scientific Sessions; June 5-8, 2026; New Orleans, LA.
2. Raynor . Individual variation: why representation in nutrition research matters. Presented at: American Diabetes Association 2026 Scientific Sessions; June 5-8, 2026; New Orleans, LA.
3. Willis H. Variation: where to go for answers: 2026 ADA nutrition guidance for diabetes management. Presented at: American Diabetes Association 2026 Scientific Sessions; June 5-8, 2026; New Orleans, LA.
4. Bouhairie V. Nutrition, overweight, and obesity: practical strategies for primary care practice. Presented at: American Diabetes Association 2026 Scientific Sessions; June 5-8, 2026; New Orleans, LA.