Thursday, April 06, 2006

Diabetes: Are we Angry Yet?

The National Health and Nutrition Examination Survey (1988–1994 and 1999–2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002) reveal that not much has improved for diabetics in the United States in the last decade. On some measurements of diabetic control, things have actually gotten worse. But, you wouldn't know that from the conclusions found in the abstract of Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988–2002 that states: "Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control."

The American Diabetes Association (ADA) and the National Diabetes Eduction Program both are clear - an HbA1c higher than 7 indicates "poor control" of diabetes. Yet the data in the above full-text article shows that poor glycemic control is prevalent not in 20% of those with diabetes, but 58.7% of diabetics!

What's more, some organizations like the International Diabetes Federation (IDF) actually set the bar lower - to 6.5 or less as the target for controlled blood sugar. But for now let's not bicker about which is a more accurate measure over the long-term for health complications - something more troubling is found in the data - the number able to maintain an HbA1c of 6 or less has fallen considerably - from 23.4% of those with diabetes in the 1990's to just 16.4% in the most recent survey.

Add to that, the overall average HbA1c didn't change at all - it remained steady at 7.7% - poor control.

That, my friends, is not an improvement by any stretch of the imagination!

So while some are patting themselves on the back for "improvements" over the last decade, I implore you to look beyond the headlines and read the data and the tables in the full article. It is only with this full information can you begin the task of asking "why, with all of our advances in medicine, do we still have those with diabetes unable to adequately control their blood sugar?"

"Why do so many still have very high LDL levels (37% greater than 130), low HDL levels (68% less than 50) and often alarming levels of triglycerides (53% higher than 150)?"

"Why do one in three have high blood pressure?"

Many will challenge these questions with "well, that's the path of complications with diabetes - all we can hope to do is slow it down."

My retort - poppycock!

I'm going to state this very clearly - the ADA diet, the carbohydrate-rich, low-fat diet preached to every type II diabetic in this country - is a death sentence!

Over time it leads to less and less ability to control blood sugar adequately, leading to increased reliance on medications, increased complications and side-effects from both the poor glycemic control and medications, which in turn leads to further worsening of the condition. It's a vicious cycle and it starts with the insane recommendation to eat a low-fat, carbohydrate rich diet upon diagnosis of type II diabetes.

Back in January I wrote that Diabetics Must Demand Accountability from the ADA because "The ADA survives because we, as a nation, are not demanding they be accountable to every diabetic out there who has followed their recommendations and still are declining each day. The ADA continuing to promote the idea of managing the disease symptoms and progressive complications is NOT good enough anymore."

"Only an aggressive campaign that openly and honestly reviews every last piece of scientific data available and comprehensively details exactly what metabolic and/or endocrine improvement is seen with each option will be an acceptable start."

In the above survey data, evey last item reviewed points to problems with the recommended diet, yet there is no mention of this in the paper - the discussion is limited to medical interventions and slowing the progression of the disease rather than asking the hard question - why with all of our medical advancements, interventions and intensive education programs are we getting nowhere with glycemic control?

It's easy to blame the person with diabetes as the culprit here - if only they'd follow the guidelines - instead of asking if the guidelines are contributing to the problem. When the assumption is that the guidelines are accurate it's difficult to ask the question and even harder to persue an answer which could throw everything you think you know out the window.

I'll close here with the same challenge I wrote in Janaury:

Type II Diabetics, ask yourself, do you want to have to take medication every day for the rest of your life and progressively add more and more as the years go by?

No? Well...Demand the ADA begin to tell you the truth about restricting carbohydrate in your diet!

Demand the ADA begin to give you actual IMPROVEMENT in, not just medical management of, your metabolism, endocrine system and thus, your diabetes!


  1. Nice post. I was also quite disappointed in the "progress" (or lack thereof) we've made as a nation in diabetes management.

    Just curious - do you happen to have type 2 diabetes yourself?


  2. Wow. So you're encouraging a group at very high risk for kidney damage, high blood pressure and high cholesterol to take up a high protein diet? Wow. Do you own stock in some company that makes dialysis or defibrillator equipment or something?

    The amount of carbohydrate isn't what matters when it comes blood sugar control. I'm sorry you don't understand that. It's the glycemic index that matters. The best diet for a diabetic which will keep BG stable while not aggravating other conditions is a low-calorie diet low in protein and fat and high in complex carbohydrates. That's exactly the diet that the ADA recommends.

  3. A few research articles to chew on:

    The metabolic response to a high-protein, low-carbohydrate diet in men with type 2 diabetes mellitus. Metabolism. 2006 Feb;55(2):243-51.

    Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15-20.

    A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005 Dec 1;2:34.

    Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report. Ups J Med Sci. 2005;110(2):179-83.

    The case for low carbohydrate diets in diabetes management. Nutr Metab (Lond). 2005 Jul 14;2:16.

    Free fatty acids, insulin resistance, and corrected qt intervals in morbid obesity: effect of weight loss during 6 months with differing dietary interventions. Endocr Pract. 2005 Jul-Aug;11(4):234-9.

    Nutrition in patients with Type 2 diabetes: are low-carbohydrate diets effective, safe or desirable? Diabet Med. 2005 Jul;22(7):821-32.

    Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus. J Am Diet Assoc. 2005 Apr;105(4):573-80.

    Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005 Mar 15;142(6):403-11

    A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis. J Clin Endocrinol Metab. 2004 Dec;89(12):6193-7

    Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004 Sep;53(9):2375-82

    Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract. 2004 Sep;65(3):235-41

    Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004 Jun;89(6):2717-23

    Protein and diabetes: much advice, little research. Curr Diab Rep. 2002 Oct;2(5):457-64

    Utility of a short-term 25% carbohydrate diet on improving glycemic control in type 2 diabetes mellitus. J Am Coll Nutr. 1998 Dec;17(6):595-600

    High-fat versus high-carbohydrate enteral formulae: effect on blood glucose, C-peptide, and ketones in patients with type 2 diabetes treated with insulin or sulfonylurea. Nutrition. 1998 Nov-Dec;14(11-12):840-5

    Does a high-carbohydrate diet have different effects in NIDDM patients treated with diet alone or hypoglycemic drugs? Diabetes Care. 1996 May;19(5):498-500

    Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus. J Am Diet Assoc. 2005 Apr;105(4):573-80

    Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia. 2005 Jan;48(1):8-16

    An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003 Oct;78(4):734-41

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  5. Refer to Diabetes for
    useful information