The Transcultural Diabetes Nutrition Algorithm: From Concept to Implementation

The transcultural diabetes nutrition algorithm (tDNA) was conceptualized in 2010 in response to a growing international need for successful implementation of evidence-based recommendations. Key features of the tDNA are (1) relevance to the dysglycemic clinical spectrum encompassing pre-diabetes and type-2 diabetes (T2D), (2) a preventive care model of chronic disease, (3) emphasis on lifestyle medicine, including healthy eating patterns and physical activity, (4) applicability to multiple cultures on a global scale, and (5) utilization of clinical algorithms to facilitate implementation. The transculturalization methodology incorporates regional differences in genomics, body composition, health socio-economics, politics and food policy, food preferences and availabilities, and religious dictates. Development proceeded as follows: phase 1-creation of tDNA template primarily based on the American Association of Clinical Endocrinologists (AACE) and American Diabetes Association (ADA) clinical practice guidelines; phase 2-global summits to create regional tDNA applications; phase 3-creation of the tDNA toolkit with content validation; and phase 4 (current) -design of clinical validation studies. The tDNA program endeavors to improve clinical outcomes in pre-diabetes and T2D worldwide.