NEW YORK (Reuters Health) – The American Diabetes Association (ADA) has issued guidelines that stress the importance of medical nutrition therapy for diabetes. The guidelines, published in the January issue of Diabetes Care, emphasize the importance of determining total carbohydrate intake rather than focusing on the carbohydrate source.
The current recommendations are based on research findings generated since the ADA released its last nutrition guidelines in 1994. The ADA reviews and updates its guidelines every 5 to 7 years to keep pace with current scientific developments.
In the current guidelines, the ADA graded each recommendation according to the strength of the supporting research. Recommendations with strong, some, and limited supporting evidence were classified as A, B, and C level, respectively. The weakest recommendations are those based on expert consensus or clinical experience.
The 2002 guidelines de-emphasize the importance of the glycemic index of foods. The source or type of carbohydrates is not as important as the total amount of carbohydrates in meals and snacks. Furthermore, the ability of patients to adhere to low glycemic index diets and derive glycemic benefit has not been established.
Diabetics can eat sucrose and sucrose-containing foods, but these items should be substituted for other carbohydrate sources or covered with insulin or other glucose-lowering drugs, the report states. Use of non-nutritive sweeteners is acceptable if daily intake does not exceed amounts set by the US Food and Drug Administration.
"We're still working on getting the message out about sugar and trying to explain that it's all foods [diabetics] need to pay attention to," Anne Daly, the ADA's president of Health Care and Education, said in an interview with Reuters Health.
The ADA also points out the lack of evidence supporting the safety and efficacy of current fad diets, such as The Zone, Atkins, Fit for Life, and Sugar Busters. These low carbohydrate diets promote short-term weight-loss and improved glycemia, but the long-term efficacy has not been established. In addition, concern has been raised regarding the long-term effects of these diets on kidney and cardiovascular disease risk.
Diabetes Care 2002;25:202-212.
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