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

Recommendations
  •  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

13 comments:

Vetrimagal said...

Thank you very much.
After buying your book , reading it and following it, after modifying to suit my culture and food habits,I was plagued with the question of low card/high protein and what it will do to my kidneys.

now your clarification has helped me to go ahead with my diet plan and monitoring.

Subrata said...

Nice and informative post.
I would like to add, everything in moderation except smoking, including laughter in moderation can be a part of healthy lifestyle.

canadianonlinepharmacy said...
This comment has been removed by a blog administrator.
EMR said...

It is a complicated with diabetes when you do not know what to eat and how much and what could keep it under control specially after the kidney gets affected.

Anonymous said...
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World Institute of Surgical Excellence said...

I really appreciate what you are doing with hosting a blog that serves as not only an education tool for those whom are living with diabetes, but also a tool for those whom have loved ones who suffer from diabetes. Several of my family members have type 2 diabetes and although they learn to make adjustments and live with it, there are several aggrevations that tend to plague there naturally jovial attitudes at times. Hosting a blog for education on living with diabetes is a wonderful thing and I will be sharing this with my family; thank you.

Signs of diabetes said...

Nice and informative post. Thank you!

Dilip said...

Alan,

The doctor told my wife a few days ago that she is diabetic when the tested 207mg/ml fasting. We got the test repeated today and it was 190. The doc prescribed metformin but instead of starting on the medicine, my wife wants to bring it down by eating/exercise changes. Do you think it is the right thing to do? Or should she start on the medicine?

I am posting here because I could not find your email address in the blog. Apologies.

Thanks
Dilip

Alan said...

Dilip, you've asked me a question I am not qualified to answer. I am a diabetic, not a doctor.

I can only recommend that she follows her doctor's advice. If in any doubt ask the doctor.

Two points to note.

1. Metformin may have gastric side effects in some people. Most doctors start patients on a low dose and ramp up over a few weeks to the full dose to minimise those effects. If she has the side effects discuss that with the doctor immediately.

2. Metformin does not cause low blood glucose levels. There is no reason why she cannot try the testing and diet suggestions in this blog to improve her diabetes management in addition to the medication. At some future time she might discuss ceasing the metformin with her doctor if her blood glucose levels improve sufficiently.

Anonymous said...

Excellent post. I learned a lot reading it. Thanks.

Metformin said...

With the support of D-bloggers Scott Johnson and Kerri Sparling, more programming has been added to FFL that focuses specifically on adults with type 1.

megan said...

My grandfather was recently diagnosed with diabetes and have to update that it has been tough on him as he doesn't know what to eat and when he should be eating.

tracy.rose@healthline.com said...

Hi Alan,

Healthline recently finished putting together a collection of the best online diabetes videos. You can find it a: http://www.healthline.com/health-slideshow/best-videos-diabetes

We encourage you to share the list with friends, followers, and subscribers.

Thank you in advance for your consideration.

Warm Regards,
Tracy