Subscribe
eNewsletter
Ready to get certified?
Free CDCES Coach App
Download
Free Med Pocket Cards
eNewsletter
Free CDCES Coach App
Free Med Pocket Cards
Dietary fiber is a complex carbohydrate and bioactive food compound that has an important role in diabetes management and cardiometabolic health. High-fiber dietary patterns are associated with a lower risk of type 2 diabetes, cardiovascular disease, obesity, gastrointestinal disorders, and certain cancers. ¹,²
In individuals with diabetes, fiber-rich eating patterns have been shown to improve glycemia, reduce postprandial glucose excursions, and improve lipid profiles. ¹ A recent meta-analysis found that for individuals with type 1 diabetes, a high- fiber diet not only supports A1c reduction but is also associated with reduced hypoglycemia risk due to its role in slowing digestion and absorption. ³ Despite this evidence most adults fail to meet recommended fiber intake guidelines, presenting an opportunity for nutrition interventions.
The Dietary Reference Intake (DRI) for fiber, established by the Institute of Medicine, along with the 2026 ADA Standards of Care ¹ , recommends 14 grams of fiber per 1,000 Calories, corresponding to an Adequate Intake of approximately 25–38 grams per day depending on age, gender, and energy needs. 4 Higher-fiber dietary patterns greater than 35 grams per day ³ and up to 50 grams per day 1 may provide additional glycemic benefits for individuals with diabetes.
Both the 2020–2025 and 2025–2030 Dietary Guidelines for Americans 5 emphasize fruits, vegetables, whole grains, and legumes as primary fiber sources; however, the recommended portions of these food groups differ between guidelines. The newly released 2025–2030 guidelines place greater emphasis on overall dietary patterns and whole-food sources, with reduced total grain servings, increased emphasis on legumes, and a prioritization of reduced processed foods rather than focusing on fiber as an isolated nutrient.
However, the Scientific Report of the guidelines does reference an optimal fiber intake range of 25–29 grams per day. ² Aligning with ADA Standards of Care, the focus shifts from individual nutrients to overall eating patterns, supporting health professionals to encourage food choices that help individuals meet evidence-based guidelines for fiber recommendations.
Despite serving-size guidance and scientific evidence on the benefits of fiber, average intake in the United States remains far below recommendations. Fewer than 5-7% of adults meet daily fiber requirements. 5 Disparities in intakes among groups have grown over time, with data from the 2017–2018 USDA Economic Research Service showing that, within Hispanic populations, fiber consumption was highest at about 9 grams per 1,000 Calories, compared with
7.7 grams per 1,000 Calories among non-Hispanic White individuals, and 7.0 grams per 1,000 Calories among Black individuals 6 .
Although the amount varies across groups, most individuals reach only 58% of the daily fiber recommendations. Inadequate intake stems from not only food preferences but tolerance, food cost and access, time constraints, nutrition literacy, as well as, other social determinants of health. To help the U.S. population meet fiber goals, practical strategies consider not only culturally relevant nutrition interventions but food assistance programs, systems planning, and community resources that improve access to fiber-rich foods.
Therapeutically, the type of fiber matters, with insoluble or soluble providing different health benefits. Insoluble fiber creates bulk within the stool and can promote bowel regularity and reduces risk of certain cancers. Whereas, soluble fiber forms a viscous gel in the gastrointestinal tract and provides metabolic benefits, including reduced postprandial glucose responses and lower cholesterol levels. 7
While not specific to type, understanding fiber claims on food labels is a practical entry point for guiding individuals toward higher-fiber food choices. According to FDA labeling regulations, foods may be labeled a “good source” of fiber if they provide 10–19% of the Daily Value per serving (≥3 grams), while an “excellent source” of fiber provides greater than or equal to 20% of the Daily Value per serving (≥5 grams). 8
Additionally, the FDA has approved the use of “will reduce the risk of coronary heart disease” health claims
on food packaging due the cardioprotective effects of high soluble fibers β-glucan (found in oats and barley) and psyllium. 9 Emphasizing dietary patterns, food quality assessment, label literacy, and considerations for additional functional fiber supplementation can support individuals with diabetes to make informed food choices and shifts in their intake.
Practical strategies to promote higher fiber intake are outlined in the 2026 ADA Standards of Care¹ (Check out Nutrition Behaviors to Encourage ¹ within section 5: Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes) and can be reinforced through simple, actionable “High-Five for Fiber” tips.
These tips are a catchy way to encourage health behaviors that may help individuals gradually add fiber (slow addition improves gut tolerance) to meet daily recommendations. Ideas can include having individuals choose at least one “high- fiber, excellent source” daily (which has more than 5 g fiber per serving), discover high soluble fiber foods, strive for five, or more, servings from vegetables and/or fruits each day, and/or “take five” to plan meals that include whole grains, fruits, vegetables, legumes, and/or nuts and seeds each week. These tips encourage choice, helping individuals find foods that fit their personal preferences, affordability, cultural traditions, and lifestyles ¹ while supporting sustainable, health-promoting dietary patterns.
References:
Focused. Flexible. Proven.
Basic & e-Deluxe CDCES Boot Camp Bundle Includes:
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Get exam-ready with confidence.
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level-up their clinical knowledge and skills.
✔ Learn at your pace with expert-led, exam-focused content
✔ Everything you need—organized, practical, and in one place
✔ Perfect for self-directed learners who want complete, person-centered content for clinical practice and exam prep.
✔ Build knowledge, sharpen test-taking skills, and prepare with confidence—on your schedule.
MK has been living with type 1 diabetes for over 52 years, most recently using an AID system. He views himself as in generally good health “for someone his age” but arrives at this annual visit reporting he recently lost his spouse of more than 46 years. For decades, they shared meals, routines, reminders, and a partnership that often supports confident diabetes self-management. Since her death, MK’s diabetes care has understandably shifted. His eating patterns are now more irregular, medications and boluses occasionally missed, and during the visit conversation, he states, “I should’ve just canceled, I am not doing well in my diabetes.”
Beneath that statement is grief, disorientation from typical patterns and routines, the profound loss of a partner who helped make daily life with diabetes manageable, and possibly more.
It is tempting to jump in and explore with MK how we can help him meet targets and increase his engagement, the way he once did, but grief is a life transition that can change priorities and capacity for self-care. For MJ it altered feelings of support, his social network, motivation, appetite, sleep, and self-efficacy. The American Diabetes Association (ADA) Standards of Care emphasize that diabetes management must be individualized and responsive to individual needs, including psychosocial. Listening and assessing changes in loneliness, social isolation, new goals and expectations, and quality of life may be “what matters most” for this visit. ¹ They also stress that treatment goals and strategies should be modified during significant life transitions, recognizing that the capacity for self-management can change over time.
Person-centered care is our clinical standard of care. Rather than centering the visit on solving assessed problems, it can focus on MK. Sitting with his grief, acknowledging the enormity of loss, and affirming that this is a transition. We can explore what success now means for MK, ensure his safety, and find new points of connection rather than isolation. This visit can support adapting diabetes management to life as it is now, not as it was.
In chronic grief, consideration of concurrent diagnoses such as adjustment disorders, depression, anxiety, lack of social support, and coping mechanisms is important. ² In older adults with depression, an increased risk of suicide had common factors, including recent death of a loved one, social isolation, or the perception of poor health. ³ Using validated screening tools may help identify individuals whose grief is significantly affecting daily functioning and requires additional assessments.
A few examples are the Patient Health Questionnaire-2 or 9 (PHQ-2 or PHQ-9) for depression, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety, and for emotional burden related to living with and managing diabetes, the Problem Areas in Diabetes Scale (PAID), and/or the Diabetes Distress Scale (DDS). 4 A recent article in Diabetes Spectrum 3 reported that the Center for Epidemiological Studies Depression Scale (CES-D), per systematic reviews, was found to be the best-supported tool for measuring depressive symptoms in people with diabetes. Positive screening results do not confirm a diagnosis; communication with the medical team to ensure adequate and ongoing interventions is needed. Referrals to behavioral health specialists, grief counseling, or peer and community support groups may also be recommended. As a resource, the American Diabetes Association has a directory of Mental Health Providers who specialize in supporting individuals with diabetes: https://diabetes.org/tools-resources/mental-health-directory.
Diabetes Care and Education Specialists often take care of individuals over time; we don’t just provide medical assessments, but provide care through significant life events such as marriages, retirements, community disasters, illnesses, changes in caregiving roles, and loss. When working with individuals like MK, presence, active listening, supportive engagement, and collaborative care planning may be the most appropriate interventions. By meeting individuals where they are, rather than where they “should” be, the CDCES supports trust, connection, and access to the care they need. In doing so, we uphold the heart of diabetes care: partnering with people through all seasons of their lives.
References:
This year’s National Nutrition Month’s theme is “Discover the Power of Nutrition.” Nutrition has the power to help individuals and communities thrive.
The nutrition profession offers diverse career pathways spanning clinical care, community health, education, research, industry, leadership, and private practice, allowing Registered Dietitian Nutritionists (RDNs), also known as Registered Dietitians (RDs), to grow and evolve their careers over time.
RDs leverage “the power of nutrition” while delivering evidence-based medical nutrition therapy (MNT) across the diabetes care continuum.
Nutrition is both a challenge and an opportunity for individuals living with diabetes and can have direct impacts on health outcomes.
As of February 2026, more than 113,900 RDNs are credentialed in the United States.1 In 2025, just over 8,600 RDNs also held the Certified Diabetes Care and Education Specialist (CDCES) credential, representing approximately 45% of all CDCES professionals2. Employment for dietitians is projected to grow by 6%3. However, the field has recently seen a decline in new graduates, likely due to post-pandemic enrollment shifts and the 2024 transition to a required master’s degree4. Supervised practice hours and passing the national examination continue to be required. Despite these challenges, the RDN credential remains the gold standard for evidence-based nutrition practice and new career opportunities continue to evolve.
Dietitians in diabetes care practice in a wide range of settings, including hospitals and outpatient clinics, primary care and endocrinology offices, federally qualified health centers, public health programs, academia, digital health, industry, community-based organizations and more. Increasingly, entrepreneurship has also emerged as another pathway. Approximately 12% of RDNs in the United States are self-employed.5
ADCES recently launched an Entrepreneurship Community of Interest (COI) group, leaning into this growing career trend. For many dietitians, private practice offers an opportunity to meet an unmet need or specialization, schedule flexibility, and a space to design new programs and interventions.
Both the American Diabetes Association and the Academy of Nutrition and Dietetics recommend referral to MNT for individuals with diabetes, yet fewer than 10%6 receive these services. Barriers include limited access to RDNs within health systems, fragmented referral networks, and inconsistent insurance coverage for nutrition care.7 These gaps in access were a key motivator for my own entrepreneurial venture, reinforcing that many successful innovations are often driven by unmet needs.
In 2023, I founded Nutrition for Daily Living to help address access barriers within my own local community. Building a business required learning the business of nutrition including marketing, finances, legal requirements, and navigating insurance for MNT. What began as a part-time side hustle has now become a full-time practice, enabling me to work towards my goal of delivering personalized care while fostering long-term partnerships with clients. No matter your setting, innovation can start with awareness and creativity and when paired with courage, it can open doors to meaningful impact and success.
Dietitians in diabetes care play an important role in advancing our profession by bridging nutrition innovations, clinical care expertise, behavioral strategies, and collaboration with patients, communities, and care teams. With the increasing complexity of diabetes management, RDNs bring essential skills in leadership, problem-solving, and patient-centered care. Individuals with an entrepreneurial spirit, no matter the care setting, can pilot new approaches, identify unmet needs, and design new care models. As we celebrate National Nutrition Month together, let’s recognize the many important contributions RDNs provide in transforming diabetes care.
References:
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Get exam-ready with confidence.
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level-up their clinical knowledge and skills.
✔ Learn at your pace with expert-led, exam-focused content
✔ Everything you need—organized, practical, and in one place
✔ Perfect for self-directed learners who want complete, person-centered content for clinical practice and exam prep.
✔ Build knowledge, sharpen test-taking skills, and prepare with confidence—on your schedule.
Focused. Flexible. Proven.
Basic & e-Deluxe CDCES Boot Camp Bundle Includes:
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Get exam-ready with confidence.
Our comprehensive BC-ADM Online Study Programs are specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) exam.
✔ Learn at your pace with expert-led, exam-focused content
✔ Everything you need—organized, practical, and in one place
✔ Perfect for self-directed learners who want complete, person-centered content for clinical practice and exam prep.
✔ Build knowledge, sharpen test-taking skills, and prepare with confidence—on your schedule.
Focused. Flexible. Proven.
Basic & e-Deluxe BC-ADM Boot Camp Bundle include:
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more!
