This is the current release of the guideline.

Diabetes mellitus

Management
Prevention

Endocrinology
Family Practice
Internal Medicine
Nutrition
Preventive Medicine

Dietitians
Physicians

To review the available scientific data regarding the effect of the type or source of carbohydrate on the prevention and management of diabetes and to clarify the position of the American Diabetes Association on this important topic

Individuals with diabetes

Regulation of blood glucose by monitoring the amount and type of carbohydrates in food

• The effectiveness of glycemic index on overall blood glucose control
• The utility of glycemic load

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review
Review of Published Meta-Analyses

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

American Diabetes Association Statements are reviewed externally and also by the Professional Practice Committee for overall content.

• Regulation of blood glucose to achieve near-normal levels is a primary goal in the management of diabetes, and, thus, dietary techniques that limit hyperglycemia following a meal are likely important in limiting the complications of diabetes.
• Low-carbohydrate diets are not recommended in the management of diabetes. Although dietary carbohydrate is the major contributor to postprandial glucose concentration, it is an important source of energy, water-soluble vitamins and minerals, and fiber. Thus, in agreement with the National Academy of Sciences-Food and Nutrition Board, a recommended range of carbohydrate intake is 45-65% of total calories. In addition, because the brain and central nervous system have an absolute requirement for glucose as an energy source, restricting total carbohydrate to <130 grams/day is not recommended.
• Both the amount (grams) of carbohydrate as well as the type of carbohydrate in a food influence blood glucose level. The total amount of carbohydrate consumed is a strong predictor of glycemic response, and, thus, monitoring total grams of carbohydrate, whether by use of exchanges or carbohydrate counting, remains a key strategy in achieving glycemic control.
• A recent analysis of the randomized controlled trials that have examined the efficacy of the glycemic index on overall blood glucose control indicates that the use of this technique can provide an additional benefit over that observed when total carbohydrate is considered alone.
• Although this statement has focused primarily on the role of carbohydrate in the diet, the importance of achieving/maintaining a healthy body weight (particularly in type 2 diabetes) in the management of diabetes should not be ignored. Moderate weight loss in overweight/obese individuals with type 2 diabetes results in improved control of hyperglycemia as well as in a reduction in risk factors for cardiovascular disease.
• Because much of the risk of developing type 2 diabetes is attributable to obesity, maintenance of a healthy body weight is strongly recommended as a means of preventing this disease. The relationship between glycemic index and glycemic load and the development of type 2 diabetes remains unclear at this time.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Improved glycemic control based on knowledge regarding the effect of the type or source of carbohydrate on the prevention and management of diabetes
• The findings of a meta-analysis indicate that implementing a low-glycemic index diet lower A1C values by 0.43% when compared with a high-glycemic index diet.

Not stated

At this time, there is insufficient information to determine whether there is a relationship between glycemic index or glycemic load of diets and the development of diabetes. Prospective randomized trials will be necessary to confirm the relationship between the type of carbohydrate and the development of diabetes.

An implementation strategy was not provided.

Living with Illness
Staying Healthy

Effectiveness

Not applicable: The guideline was not adapted from another source.

2004 Sep

American Diabetes Association - Professional Association

American Diabetes Association (ADA)

Not stated

Primary Authors: Nancy F. Sheard, SCD, RD, Department of Family Practice, University of Vermont, Burlington, Vermont; Nathaniel G. Clark, MD, MS, RD, American Diabetes Association, Alexandria, Virginia; Janette C. Brand-Miller, PHD Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, Sydney, Australia; Marion J. Franz, MS, RD, CDE, Nutrition Concepts by Franz, Minneapolis, Minnesota; F. Xavier Pi-Sunyer, MD, MPH, Division of Endocrinology, Diabetes and Nutrition, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York; Elizabeth Mayer-Davis, PHD, RD, Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Karmeen Kulkarni, MS, RD, CDE, BC-ADM, St. Mark's Diabetes Center, Salt Lake City, Utah; Patti Geil, MS, RD, FADA, CDE, Diabetes Care and Communications, Lexington, Kentucky

Janette C. Brand-Miller, PHD is on the board of directors of Glycemic Index Limited.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on April 19, 2005.