Weight loss through dietary modification is key to type 2 diabetes self-management, yet few nationally representative data exist on dietary trends among people with diabetes.

To examine dietary changes, via nutrient intakes, among US adults with diabetes between 1988 and 2004.

Nutrition data from the cross-sectional National Health and Nutrition Examination Surveys (Phase I: 1988-1990 and Phase II: 1991-1994) and 1999-2004 of adults with self-reported diabetes were examined. Twenty-four–hour dietary recall data were used to assess changes in energy; carbohydrate; protein; total, saturated, polyunsaturated, and monounsaturated fat; cholesterol; fiber; sodium; and alcohol intake.

Consumption of total energy and specific nutrients per day were estimated by survey, controlled for age and sex, using multiple linear regression and adjusted means (with standard errors).

Between 1988 and 2004 there was no significant change in self-reported total energy consumption among adults with self-reported diabetes (1,941 kcal/day in 1988-1990 to 2,109 kcal/day in 2003-2004, P for trend=0.22). However, there was a significant increase in the consumption of carbohydrate (209 g/day in 1988-1990 to 241 g/day in 2003-2004; P for trend=0.02). In analyses stratified by age group, changes in dietary consumption were noted among persons aged 45 to 64 years; specifically, increases in total energy (1,770 to 2,100 kcal/day, P for trend =0.01) and carbohydrate consumption (195 to 234 g/day, P for trend=0.02).

Despite recommendations to lose weight, daily energy consumption by individuals with diabetes showed no significant change, except in individuals aged 45 to 64 years, where an increase was observed. Overall, there was an increase in carbohydrate consumption. Emphasizing the equal importance of energy reduction and changes in dietary composition for people with diabetes is important for optimal self-management.