Talk about timing!
Soon after posting Evidence-Based Guidelines Needed for Diabetes Diet on Friday, I received an email alerting me to the release of the September 2006 issue of Diabetes Care online. Within the new issue is the latest update to the ADA's Medical Nutrition Therapy [MNT] recommendations in Nutrition Recommendations and Interventions for Diabetes–2006: A position statement of the American Diabetes Association.
The full-text is available here (requires payment).
Surprisingly, there is little attention in the media - since Friday, there have only been a handful of articles relating to the updated recommendations. The few published are almost all identical in wording and based on the press release issued on Friday by the ADA.
The position statement is the second major update released by the ADA in less than a month. You may recall my previous article, ADA Consensus Statement Admits Recommended Lifestyle Intervention Fails; Solution: Medication, that highlighted the release of the new treatment algorithm, Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD], in the August issue of Diabetes Care.
These two documents now stand as the "gold standard" for physicians and healthcare providers to determine the course of treatment for their patients at risk for or diagnosed with diabetes. While both documents claim an evidence-based approach in their creation, they rely heavily on previous reviews and time-honored dogma.
They also quietly tell us something that should make physicians and healthcare providers, and the general public question the trust bestowed upon the ADA as the leading, authoritative organization to find a cure, and more importantly be responsible to us for communicating the best science available. After decades of research time, millions of dollars, and billions of manhours - the ADA has not only failed find a solution to prevent diabetes, it is also currently unable to curtail the epidemic of diabetes.
While admitting the "current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes," they continue down the very same path that leads to slow, insidious progression of the disease.
One example of this from the new MNT guidelines should suffice to highlight the insanity of it all:
"Sucrose can be substituted for other carbohydrate sources in the meal plan or, if added to the meal plan, adequately covered with insulin or another glucose-lowering medication."
In other words, it's fine to make your condition worse as long as you take and adjust your drugs.
I could spend hours picking apart the various recommendations that are destructive to the long-term health of those at risk for or diagnosed with diabetes, and then pull dozens of credible studies that found improvement with an alternative approach. I simply do not have that kind of time these days.
I have however, previously written a number of articles that sum up much of the research data available that has continued to be ignored:
Rather than taking the time - and let me be clear, it is a time consuming process - to actually review the reams of data available that specifically found statistically significant improvements in those subjects with insulin resistance and impaired glucose tolerance or diabetes following a carbohydrate restricted diet, the ADA has firmly placed its stake in a failed dietary approach and simply added a pharmacuetical intervention at diagnosis in the hope that the drugs may at least slow progression if prescribed earlier.
That's not all though.
The ADA isn't simply standing its ground, as shaky as it is, here.
They're not just ignoring evidence or dismissing data anymore - they've gone a step further to issue a blanket condemnation of a scientifically supported dietary intervention and crafted a message to healthcare providers and the public that tells them, in no uncertain terms, they can't do it anyway, so don't even bother to consider it.
In the real world, that's called hubris - only pure arrogance leads an organization the size of the ADA to declare "we know what's best for you," while at the same time admitting it isn't able to do more than stay the course and add drugs earlier.
I've reached the point where even my hope that the ADA will evaluate the evidence, take the valuable hard date available, and issue even a cautious guideline to carbohydrate restriction, has evaporated.
With these two new statements, the ADA has shown its worth in our future - a future which looks grim if nothing changes - the ADA is now irrelevant.
It is up to those who are truly committed to the use of evidence-based medicine to collaborate, unite and review the evidence to create a comprehensive guideline for use by healthcare providers. Those currently in practice and treating those at risk for or diagnosed with diabetes, and those investigating its potential, must take on the task since it's clear the ADA is not going to do it.
It's also time for those who are at risk for or diganoised with diabetes to step up and be heard - write letters to the editor of your local newspaper, the national newspapers and your congressmen. Tell them enough is enough - we want a all options, based on credible studies, provided to physicians, healthcare providers and the public!