The American Diabetes Association every January updates their Standards of Medical Care in Diabetes. The document is lengthy, highly technical, and written for healthcare providers. Some of you may appreciate it. If I were a non-physician with diabetes, I’d learn as much about it as possible. Remember, no one cares about your health as much as you do. The 2015 version of the standards is called, appropriately enough, Standards of Medical Care in Diabetes—2015.
Updates to the guidlelines include:
- recommendation not to sit inactively for over 90 minutes
- pre-meal blood sugar target is now 80 to 130 mg/dl (4.4 to 7.2 mmol/l) instead of the old 70 to 130 mg/dl
- added SGLT2 inhibitors to the drug treatment algorithm
- recommended a diastolic blood pressure goal of 90 mmHg or less instead of the old 80 mmHg or less
- increased the potential pool of statin drug users
- added a section on management of diabetes during pregnancy
Steve Parker, M.D.
The American Heart Association and American Diabetes Association just published a review paper on nonnutritive sweeteners, also known as low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners. I quote from the conclusion section:
At this time, there are insufficient data to determine conclusively whether the use of NNS to displace caloric sweeteners in beverages and foods reduces added sugars or carbohydrate intakes, or benefits appetite, energy balance, body weight, or cardiometabolic risk factors.
With regard to nonnutritive sweeteners and glycemic response [in diabetics], 4 randomized trials that varied from 1 to 16 weeks in duration found no significant difference between the effects of nonnutritive sweeteners and various comparisons (sucrose, starch, or placebo) on standard measures of glycemic response (i.e., plasma glucose and insulin, HbA1c, C-peptide) and, in general, did not detect clinically relevant effects.
You’re welcome to read the entire document.
Eighty-five percent of type 2 diabetics are overweight or obese. Overweight either causes or aggravates many cases of diabetes.
For the last quarter-century, many U.S. government agencies and healthcare organizations have advocated a low-fat diet for overweight people, including type 2 diabetics. Recent studies have documented that low-carbohydrate diets can also be effective in weight loss. Low-carb diets replace carbohydrates with either fats or proteins, or both. The A to Z Weight Loss Study compared the Atkins, Ornish, LEARN, and Zone diets in 311 overweight pre-menopausal women. The Atkins group tended to lose a bit more weight. Changes in lipid profiles, waist-hip ratios, fasting insulin and glucose levels, blood pressure, and percentage of body fat were comparable or better with Atkins versus the other diets.
The Amerian Diabetes Association now gives the go-ahead for use of low-carb diets as a weight-control method for type 2 diabetics. Previously, the organization had recommended against diets that restrict carbohydrates to less than 130 grams daily. (A baked potatoe without the skin has 30 grams.) Understand that the ADA does not endorse low-carb diets for weight loss or diabetes management. They simply say that either low-carb or low-fat calorie-restricted diets might be effective for up to one year.
I caution you that low-carb diets may be deficient in fiber, minerals, vitamins, and phytonutrients that may be very beneficial in terms of long-term health and longevity.
The tide has been turning against low-fat diets for the last six years.
Steve Parker, M.D.
Reference: American Diabetes Association. Clinical Practice Recommendations 2008. Diabetes Care, 31 (2008): S61-S78.