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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the importance of individualizing carbohydrate intake in treating diabetes and shared some of the evidence that was considered when updating the American Diabetes Association (ADA) recommendations [Evert AB et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus Obesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENutrition Physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn a symposium on the new \u201cNutrition Therapy Recommendations for the Management of Adults With Diabetes,\u201d William S. Yancy Jr, MD, VA Medical Center and Duke University School of Medicine, Durham, North Carolina, USA, discussed the importance of individualizing carbohydrate intake in treating diabetes and shared some of the evidence that was considered when updating the American Diabetes Association (ADA) recommendations [Evert AB et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EFor many people with diabetes, their biggest challenge is determining what to eat, particularly with respect to carbohydrates. And while the ADA does not recommend any specific eating plan for people with diabetes, it does emphasize that lifestyle and metabolic needs should be considered when choosing one eating pattern over another.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EWhen considering the evidence for patients with diabetes following a low-carbohydrate diet, Dr. Yancy referred to a landmark study involving a strict low-carbohydrate diet in 10 adults with obesity and type 2 diabetes mellitus (T2DM). After following their normal diet for 7 days, participants switched to a low-carbohydrate diet (\u223c 21 g\/day carbohydrate) for 14 days. The low-carbohydrate diet significantly lowered their levels of plasma glucose (p\u0026lt; .05) and HbA1C (from 7.3% to 6.8%; p\u0026lt; .006) [Boden G et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe results of a subsequent meta-analysis of trials evaluating the effects of carbohydrate-restricted diets (\u0026lt; 45% of calories) in patients with T2DM also showed improvements in HbA1C levels as the percentage of calories from carbohydrate was decreased (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Kirk JK et al. \u003Cem\u003EJ Am Diet Assoc\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Decreasing Dietary Carbohydrate on HbA1C Levels\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-264616631\u0022 data-figure-caption=\u0022Effect of Decreasing Dietary Carbohydrate on HbA1C Levels\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14604\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EEffect of Decreasing Dietary Carbohydrate on HbA1C Levels\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECarb cal = carbohydrate calories.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Kirk JK et al. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. \u003Cem\u003EJ Am Diet Assoc.\u003C\/em\u003E 2008;108:91\u2013100. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EHowever, Dr. Yancy emphasized that not all studies involving low-carbohydrate diets have shown improvement in glycemic control [Daly ME et al. \u003Cem\u003EDiabet Med\u003C\/em\u003E 2006; Davis NJ et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2009; Iqbal N et al. \u003Cem\u003EObesity\u003C\/em\u003E 2010]. He also noted that retention levels were low in some studies involving low-carbohydrate diets, and he stressed that this may be one reason why, at this point, such diets have not been endorsed as the superior option for patients with diabetes. Still, the greater glycemic improvement seen in the majority of randomized controlled trials and the potential for reduction in diabetes medications make low-carbohydrate diets a viable treatment option and one worthy of further research.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn contrast, Dr. Yancy remarked that some studies have shown high-carbohydrate diets to be helpful in patients with diabetes. In one study, glycemic and lipid control was improved in participants with T2DM who followed a high-carbohydrate, very-low-fat diet (vegan group), as well as those who followed a moderate-carbohydrate, low-fat diet based on former ADA recommendations. However, the reduction in HbA1C levels was marginally greater for all in the vegan group (p = .09) and significantly greater for those on a stable T2DM medication regimen (p = .01). Also, compared with 26% of the ADA group, 43% of the vegan group reduced the number of diabetes medications during the trial, mainly as necessitated by hypoglycemia [Barnard ND et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe results of the Look AHEAD (Action for Health in Diabetes) study was also reviewed, which compared the effects of an intensive lifestyle intervention (ILI) with diabetes support and education (DSE) in T2DM [Look AHEAD Research Group. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2010]. Data showed that ILI resulted in a greater improvement in HbA1C than did DSE (\u20130.36% vs \u22120.09%; p\u0026lt; .001) over a 4-year period.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EConsequently, the new recommendations note that the evidence is inconclusive regarding an ideal amount of carbohydrate intake for patients with diabetes, Dr. Yancy stated. He added that while the amount of carbohydrates and available insulin may be the most important factors that influence the glycemic response after eating, higher doses of insulin and several other diabetes medications can lead to unwanted effects, such as weight gain and hypoglycemia. Monitoring carbohydrate intake therefore remains key to glycemic control, and the new recommendations place emphasis on carbohydrate origin. Dr. Yancy concluded that for good health, carbohydrates should come from vegetables, fruits, whole grains, legumes, and dairy products, compared with other sources that contain added fats, sugar, or sodium.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/19\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}