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Friday, February 03, 2012

ADA Standards of Medical Care in Diabetes 2012

The ADA has just released their 2012 Position statements on several issues. A clickable set of pdf files can be found in the latest Diabetes Care Table of Contents page.

The most important document is probably the overall position paper: Standards of Medical Care in Diabetes 2012

I am posting the links immediately for those who wish to read the ADA documents for themselves in detail. I will post more detailed comments later after I have had time to analyse the full document.

A quick skim found that there are some significant changes, especially in acceptance of low-carbohydrate diets in the Medical Nutrition Therapy section. Unfortunately, they tend to still qualify that with statements like:
  • For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short term (up to 2 years). (A)
  • c For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)
With no direct acceptance that low-carb may be better for blood glucose levels, not just weight. There is some oblique acceptance:
115). A meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (116).
 and earlier in the paper:
Macronutrients in diabetes management

  •  The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. (C)
  • Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control. (B)
  • Saturated fat intake should be <7% of total calories. (B)
Of course, that final comment can make low-carbing difficult for some. Not for me; I simply ignore that :)

There are also some other significant changes in non-dietary areas, such as very qualified acceptance of the value of post-prandial home testing.

One of the changes that may be of concern to those who believe that diet and exercise should be tried first and medication should only be added if d&e is inadequate is this:
2. Therapy for type 2 diabetes

  •  At the time of type 2 diabetes diagnosis, initiate metformin therapy along with lifestyle interventions, unless metformin is contraindicated. (A)
There is a lot more; take a little time to read the papers in depth.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter