The American Diabetes Association (ADA) revises its Clinical Practice Recommendations yearly, and the 2008 version includes more changes than usual. Besides several substantive additions, there was an effort to streamline the document, “to pare down recommendations to focus on primary treatments that are known to benefit people with diabetes,” says Sue Kirkman, MD, vice president of clinical affairs for the association.

A broader approach to weight control is perhaps the most striking change in policy, but sections on screening, hypoglycemia, and the treatment of older adults should be of particular interest to primary-care physicians as well, she says.

Expanding the diet options

As was the case in earlier versions, weight loss is a key recommendation for overweight individuals who have or who are at risk of diabetes. However, the 2008 guidelines note that “either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to one year).” Previously the ADA did not recommend low-carbohydrate diets because of insufficient data documenting their safety and efficacy.

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“Obesity is a big problem, and many studies show that adherence to a diet is the most important determinant of weight loss, not which diet it is,” Dr. Kirkman observes. “Different people adhere to different diets. A lot of clinical trials have shown at least equivalent weight loss with low-carb diets…it didn’t seem reasonable to advise against one strategy.”

Because individuals on low-carbohydrate diets are likely to increase intake of other macronutrients, the Recommendations also advocate monitoring of lipid profiles, renal function, and (in the presence of nephropathy) protein intake.