Diabetes Self-Management Blog

On Friday, December 28, the American Diabetes Association (ADA) issued its 2008 Clinical Practice Recommendations, which are a set of guidelines that help health-care providers treat people with diabetes based on the most current scientific evidence. One key change in this year’s recommendations is the inclusion of low-carbohydrate diets as an option for people with diabetes who are trying to lose weight.

According to the “Medical Nutrition Therapy” section of the new guidelines, “either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short-term (up to 1 year)” for weight loss in people with diabetes. This statement represents a significant reversal from the ADA’s former position on low-carbohydrate diets. For instance, the agency’s 2007 recommendations stated that such diets were not recommended for the treatment of overweight/obesity—even in the short term—because their long-term effects were unknown and they did not seem to provide better maintenance of weight loss than low-fat diets over the long term. But in a press release that accompanied the publication of the 2008 recommendations, the ADA has stated that “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.”

In the same press release, ADA President of Health Care & Education Ann Albright, Ph.D., R.D., stated that “We’re not endorsing either of these weight-loss plans over any other method of losing weight.” More important, she said, is that people with diabetes choose a weight-loss plan that works for them, and that their health-care team supports their efforts and monitors their health accordingly.

Indeed, the ADA’s new guidelines lay out specific instructions for monitoring the health of people who are on low-carbohydrate diets. Because people following these eating plans may replace calories from carbohydrate with fat or protein, the ADA recommends that health-care providers monitor their lipid profiles (including cholesterol and triglyceride levels). Because extra protein in the diet may make kidney problems worse, the ADA also recommends that people with nephropathy have their kidney function monitored and be counseled about including the correct amount of protein in their diets. Finally, the new recommendations point out that providers may need to adjustment the blood-glucose–lowering drug therapy of people who reduce their carbohydrate intake.

The “low-carb vs. low-fat” diet debate has been raging in the diabetes community for some time. On our own blog, David Spero addressed it in his post “Carbs vs. Fats—Who’s to Blame?”—he argued in favor of low-carbohydrate diets, and many readers shared comments detailing their own experiences with them. Jan Chait, who favors the low-fat approach for her needs, responded with her own post on the subject, “Fitting Diabetes Into Your Lifestyle.” The ADA’s revised recommendations reflect the growing evidence that either approach, combined with regular physical activity, can be an effective choice for those who need to lose weight.

Some other changes present in this year’s Clinical Practice Recommendations include new guidelines on maintaining a diabetes “disaster kit” to be used in case of emergency; revisions and additions to treatment recommendations for older adults with diabetes and children and adolescents with Type 1 diabetes; a new section on Type 1 diabetes and hypothyroidism; and new emphasis on statin drug treatment for lipid level management and ACE inhibitor or ARB drug treatment to treat high blood pressure and nephropathy.

The ADA’s full annual Clinical Practice Recommendations were published in a supplement to the January 2008 issue of the journal Diabetes Care. You can find a summary of the revisions to the Clinical Practice Recommendations here and a summary of the full “Standards of Medical Care in Diabetes—2008″ here.


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