Standards of Medical Care in Diabetes- 2013

gddrdld

In case anyone is interested...Here is the updated standards of practise for the treatment of diabetes in healthcare for 2013 from the ADA. These are the standards by which medical professionals like Dr.'s, RD's and CDE's whom work with the diabetic population in the US are encouragd to practise. You can click on "full text" to read the entire article.

http://care.diabetesjournals.org/content/36/Supplement_1/S11.extract.html?etoc

Chief_Rocka

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

PaulW2MD

Thanks....will read later. Diabetics are plaque monsters and reducing saturated fats would be prudent.

AlabasterVerve

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

Bakkasan

Been trying to get my wife on the omnipod, hoping insurance will cover it this coming year. Type 1 on shots have a horrible issue with fat loss because of the cycle of insulin to fight food and food to fight overshooting insulin. A pump helps change that dynamic so immensely.

BlackTimber

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

gddrdld

Been trying to get my wife on the omnipod, hoping insurance will cover it this coming year. Type 1 on shots have a horrible issue with fat loss because of the cycle of insulin to fight food and food to fight overshooting insulin. A pump helps change that dynamic so immensely.

As a diabetes educator, I am a huge advocate for pump therapy. Good luck with the process. Omnipod is a good choice.

bcattoes

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

This is just a guess, but it's probably because both diabetes and a diet high in saturated fats have been associated with increased risk of heart disease.

AlabasterVerve

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

No, they shouldn't but they did but since the current studies show that's there's no link between saturated fat and CVD or mortality I assume the dietary recommendations will eventually catch up to the science.

gddrdld

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

I agree with this....I was really hoping to see some updated guidelines showing more of a deliniation between trans and sat fats. There is mounting evidence to suggest that not all types of saturated fats (if any) contribute significantly to plague buildup in the arteries and/or the production of LDL cholesterol in the liver. The standards of care, however, do not change rapidly and/or significantly in response to scientifc data. The large body of evidence still supports the blanket recommendation of reducing total saturated and trans fats as a general rule for diabetics as they are at very high CVD risk. However, in practise, as an RD/CDE, when working 1-1 with these patients, I have the ability to discuss current research and make specific recommendations as i see fit for the individual, as do the patients primary care physician. If you read the section on dietary treatment, it speifies that nutritional recommendations should be determined by the RD and made specific to the individuals needs (paraphrasing).

Chief_Rocka

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

I agree with this....I was really hoping to see some updated guidelines showing more of a deliniation between trans and sat fats. There is mounting evidence to suggest that not all types of saturated fats (if any) contribute significantly to plague buildup in the arteries and/or the production of LDL cholesterol in the liver. The standards of care, however, do not change rapidly and/or significantly in response to scientifc data. The large body of evidence still supports the blanket recommendation of reducing total saturated and trans fats as a general rule for diabetics as they are at very high CVD risk. However, in practise, as an RD/CDE, when working 1-1 with these patients, I have the ability to discuss current research and make specific recommendations as i see fit for the individual, as do the patients primary care physician. If you read the section on dietary treatment, it speifies that nutritional recommendations should be determined by the RD and made specific to the individuals needs (paraphrasing).

Got it, thanks.

jahilmer

Thanks soooooooooo much. I bookmarked this page and as you know....I am trying to help my husband. You are a great friend and have helped me understand things. I really appreciate you! Jane in Montana

gddrdld

Thanks soooooooooo much. I bookmarked this page and as you know....I am trying to help my husband. You are a great friend and have helped me understand things. I really appreciate you! Jane in Montana

Thank you, Jane! I'm glad you find this helpful! :0)

BigGuy47

From the report:

Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients:

This is wrong. Bad medical practice. "Regardless of baseline lipid levels" ?

Statins have a wide range of negative side effects; increased blood sugar, muscle pain/damage, liver damage, and others.

I'm type 2 and my doctor tried to put me on statins, I said no thanks. My lab work is very good due to the changes I've made in my diet and exercise.

http://www.mayoclinic.com/health/statin-side-effects/MY00205

Call me crazy, but I think the millions in contributions ($15 million in 2011) to the ADA from the Pharmaceutical industry may have something to do with recommending the administration of statins regardless of lab results.

http://www.diabetes.org/donate/sponsor/pharmaceutical_financial_revenues_2011.pdf

bcattoes

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

And some that are associated with disease risk. But when making a general recommendation it's not so easy to delineate the different types. Most people want short "do this, not that" guidelines. So, all saturated fats are lumped together. It's not a bad practice. Anyone that wants to know more will take the time to learn more, those that won't are better off limiting all of them.

AlabasterVerve

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

And some that are associated with disease risk. But when making a general recommendation it's not so easy to delineate the different types. Most people want short "do this, not that" guidelines. So, all saturated fats are lumped together. It's not a bad practice. Anyone that wants to know more will take the time to learn more, those that won't are better off limiting all of them.

Lumping trans fats and saturated fats together is just bad science -- perhaps understandable at the time -- but that doesn't change the fact that they're completely different and the recommendations to limit saturated fat aren't evidence based at all.

gddrdld

This was in the "Care" section:

"Saturated fat intake should be <7% of total calories"

What's the rationale behind this as it relates to diabetes?

It's not evidence based just the same saturated fats are bad type thing:

"Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD (123,145)."

You shouldn't lump Trans fats with Saturated fats. There are quite a few very healthy saturated fats.

And some that are associated with disease risk. But when making a general recommendation it's not so easy to delineate the different types. Most people want short "do this, not that" guidelines. So, all saturated fats are lumped together. It's not a bad practice. Anyone that wants to know more will take the time to learn more, those that won't are better off limiting all of them.

Lumping trans fats and saturated fats together is just bad science -- perhaps understandable at the time -- but that doesn't change the fact that they're completely different and the recommendations to limit saturated fat aren't evidence based at all.

**Keep in mind when reading this, it is meant and therefore written for, clinician use and therefore may not be a good practical use tool for the general public. I say this because people may tend to pck out "one line" to criticize and/or analyze from a very narrow prospective and this is not how the guidelines are used in practise by MD's, RD's, and CDE's, etc (licensed medical). The guidelines are based on a large body of research and not just a few studies and are subject to interpretation by individual medical professionals. (disclaimer)**

redladywitch

Thank you for posting this. I do appreciate the information very much.