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Meta-Analysis of Low-Glycemic Index Diets in the Management of Diabetes

Response to Franz

From the Nutrition Department, University of Otago, Dunedin, New Zealand

Address correspondence to James I. Mann, Nutrition Department, University of Otago, P.O. Box 56, Science II Building, Union Street, Room 7N8, Dunedin, New Zealand. E-mail: beth.gray{at}stonebow.otago.ac.nz

In her editorial (1) accompanying the meta-analysis carried out by Brand-Miller et al. (2), Dr. Franz describes the glycemic index as "not the most effective nutrition therapy intervention." Her conclusion appears principally based on the fact that the reduction in HbA_1c by 0.4–0.6% units (a 7.4% decrease in glycated protein is equivalent to 0.6% HbA_1c units) when comparing high–and low–glycemic index diets is less than that seen when considering other dietary manipulations, which may achieve decreases in HbA_1c of 1–2% units (a 15–22% decrease in HbA_1c). Franz appears to have missed a pivotal issue clearly discussed by Brand-Miller et al. in their article (2). The observed improvement in glycemic control is the net improvement over and above that of standard current best practice nutrition therapy (and medication) in the institutions where the studies were conducted. By failing to acknowledge the additional benefit that may be achieved by the choice of low–glycemic index foods and emphasizing only the importance of total carbohydrate, the American Diabetes Association may be depriving people with diabetes of the full benefit of nutrition therapy. It is noteworthy that the recommendations of the Nutrition Study Group of the European Association for the Study of Diabetes (3) and the Food and Agriculture Organization/World Health Organization Expert Consultation on Carbohydrates (4) include advice to use the glycemic index as a means of determining the most appropriate choices of carbohydrate-containing foods.

References

1. Franz MJ: The glycemic index: not the most effective nutrition therapy intervention (Editorial). Diabetes Care 26:2466–2468, 2003[Free Full Text]
   
2. Brand-Miller J, Hayne S, Petocz P, Colagiuri S: Low–glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 26:2261–2267, 2003[Abstract/Free Full Text]
   
3. Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD): Nutritional recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutri 54:353–355, 2000
   
4. Food and Agriculture Organization/World Health Organization: Carbohydrates in Human Nutrition: Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition, 1998, p. 140 (Paper 66)
   

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This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mann, J. Search for Related Content PubMed PubMed Citation Articles by Mann, J. Social Bookmarking                What's this?