The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI) (the ranking of foods by effects on postprandial blood glucose levels) and glycaemic load (GL) (the product of mean GI and the total carbohydrate content of a meal) will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology. 1. Introduction Type 2 diabetes (T2D) is a chronic disease with hyperglycaemia as its characteristic feature, resulting from defects in insulin secretion and/or insulin action [1]. The disorder is associated with adiposity, particularly central abdominal adiposity [2], and multiple metabolic abnormalities that increase the risk of mortality from cardiovascular diseases (CVD) by two- to fourfold [3], the leading cause of death [4], shortening life by 5 to 15 years. In Canada, the prevalence of T2D is increasing at epidemic proportions, affecting more than three million Canadians, with 6 million others at elevated risk of developing the disease. Of particular concern are non-Caucasians who comprise more than 25% of the Canadian population (Figure 1) and are highly susceptible to T2D when adopting a Western lifestyle. Diabetes affects economic prosperity, costing the Canadian healthcare system $12.2 billion annually, a number that is projected to rise to $16.9 billion by 2020 [4]. Figure 1: Canadian Population Demographics. Canadian census data show that more than 200 tongues are spoken in Canada, 60 being aboriginal. The mother tongue reported by 6.8 million Canadians (21% of the population) differs from
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