Evidence-Based Nutritional Recommendations for the Treatment and Prevention of Diabetes and Related Complications
A European perspective
- Jim Mann, MD1,
- Kjeld Hermansen, MD2,
- Bengt Vessby, MD3,
- Monika Toeller, MD4 and
- for the Diabetes Nutrition Study Group of the European Association for the Study of Diabetes
- 1Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- 2Department of Endocrinology and Metabolism, Aarhus Amtssygenhus, Aarhus, Denmark
- 3Department of Geriatrics, University of Uppsala, Uppsala, Sweden
- 4Deutsches Diabetes-Forschungsinstitut and der Heinrich-Heine-Universitat Deutsche Diabetesklinik, Dusseldorf, Germany
We read with interest the revised 2002 Clinical Practice Recommendations as they relate to nutrition therapy for diabetes (1) as well as the associated Technical Review (2). We would strongly endorse the need to individualize this component of treatment because advice is indeed necessary regarding other aspects of lifestyle, oral hypoglycemic agents, and insulin. However, we question some of the recommendations regarding dietary carbohydrates.
The need for evidence-based guidelines in all aspects of medical management is universally recognized. Unfortunately, with regard to nutritional recommendations, there are no randomized-controlled clinical trials with morbidity and mortality as end points. These are regarded as the ultimate type of evidence on which to make recommendations. We therefore have to use less conclusive approaches to study, including several different epidemiological methods and studies of dietary manipulations on surrogate end points known to be related to morbidity and mortality. This inevitably leads to subjective interpretation regarding the quality of studies because it is clearly inappropriate to simply count the numbers of investigations pointing in one direction or another. Furthermore, there is need to determine the emphasis that should be given to one type of evidence compared with another. …
