New clinical practice recommendations to help health care providers treat people with diabetes

The American Diabetes Association (ADA) has issued its annual Clinical Practice Recommendations to help health care providers treat people with diabetes using the most current evidence available.

This year, one notable change occurs in the Medical Nutrition Therapy section dealing with weight loss. Until now, the ADA did not recommend low carbohydrate diets because of lack of sufficient scientific evidence supporting their safety and effectiveness. The 2008 Recommendations include a statement recognizing the increasing evidence that weight-loss plans that restrict carbohydrate or fat calorie intake are equally effective for reducing weight in the short term (up to one year). The “Standards of Medical Care in Diabetes—2008” document reviews the growing evidence for the effectiveness of either approach to weight loss. In addition, there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow.

As it has in the past, the ADA continues to emphasize the importance of sustained, moderate weight loss and increased physical activity for people who are overweight or obese and at risk for diabetes or living with diabetes.

“The risks of overweight and obesity are well known. We recognize that people are looking for realistic ways to lose weight,” said Ann Albright, PhD, RD, President, Health Care & Education, American Diabetes Association. “The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We're not endorsing either of these weight-loss plans over any other method of losing weight. What we want health care providers to know is that it's important for patients to choose a plan that works for them, and that the health care team support their patients' weight loss efforts and provide appropriate monitoring of patients' health.”

Because people following low carbohydrate diets may replace calories from carbohydrate with fat or protein, the recommendations also include monitoring the lipid profile (blood fats, including cholesterol and triglycerides) of patients on such diets. High protein diets may also worsen kidney problems. Therefore, it is also recommended that patients with kidney disease be counseled about appropriate intake of protein and that their kidney functions be monitored carefully.

“Short-term weight loss is beneficial, but what is most important for health is keeping the weight off long-term,” said Albright. “We also want to continue to emphasize the importance of regular physical activity, both to aid weight loss from calorie-restricted diets, and also for the positive health gains associated with exercise that are independent of weight loss.”

Being overweight or obese and inactive are major contributing factors to the onset of type 2 diabetes. Overweight and obesity also complicate the treatment of diabetes (both type 1 and type 2) and can contribute to the development of other health problems, such as heart disease and cancer. In the United States, rates of type 2 diabetes in adults and children have risen dramatically in recent years, along with the national epidemic of obesity.

This year's revisions also include:

• Recommendations that adults who are overweight or obese and have one or more diabetes risk factor be tested for pre-diabetes and diabetes
• New treatment guidelines for older adults
• Recommendations for preparing and maintaining disaster kits for diabetes self-management
• Structural changes to make the documents more “user-friendly,” incorporating an Executive Summary, screening recommendations and diagnostic cut-point tables, along with general treatment information.