Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
Updated Diabetes Clinical Practice Guidelines
The following two clinical practice guidelines (CPGs) have been updated:
- Diabetes Canada: 2018 Clinical Practice Guidelines and Quick Reference Guide
- Diabetes UK: Evidence-based Nutrition Guidelines for the Prevention and Management of Diabetes (March 2018)
The PEN Team is in the process of adding these guidelines to the 13 diabetes knowledge pathways in PEN.
A recent study in The Lancet Diabetes & Endocrinology journal raises the question - are more classifications of diabetes needed? Using data from five cohorts, the researchers conducted a data-driven cluster analysis in individuals newly diagnosed with diabetes (aged 18-97 years; n=8980) focused on six variables. These variables included measurement of glutamate decarboxylase antibodies, age at diagnosis, BMI, A1C and homeostatic model assessments - two estimates of β-cell function and insulin resistance. Results were replicated in three of the cohorts (n=5795). Five clusters were identified, each demonstrating different characteristics and risk of diabetes complications. Cluster 1 (autoimmune), 2 (insulin-deficient) and 3 (insulin-resistant) were classified as severe. Cluster 4 (obesity-related) and 5 (age-related) were classified as mild. The authors concluded that a refined classification, particularly for type 2 diabetes, could help tailor treatment regimes and help identify at diagnosis those with increased risk of complications. Potential client health actions or inactions with diagnoses ranging from mild to severe were not addressed. The authors plan to conduct further research on the optimal classification of diabetes subtypes.
Article Analysis: Intensive Lifestyle Counselling and Improving Glycemic Control
Plant-based Diet for the Management of Type 2 Diabetes
A review of the literature was conducted on the use of a plant-based diet in the management of type 2 diabetes as recommended by the Canadian Diabetes Association (1). Thirteen studies met the inclusion criteria. The authors defined a plant-based diet as: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs as well as all refined and processed foods”. In observational studies the consumption of a plant-based diet was associated with decreased prevalence of type 2 diabetes. The observational studies may be limited in accuracy since people on plant-based diets tend to be more physically active, have more education, and have lower BMIs, which could account for some or all of the differences in diabetes prevalence. In addition, intervention studies indicate that a plant-based diet is equal to, or more effective than, other diets in managing type 2 diabetes. Plant-based diets were associated with improving body weight, cardiovascular risk factors and insulin sensitivity. Two of the five intervention studies recommended lower glycemic load foods only for their plant-based diet intervention groups, which may have contributed to the positive findings. It is not clear whether the benefits seen in the intervention studies were due to a lower consumption of meat and animal products and/or refined and processed foods or due to an increased consumption of vegetables. Recommendations are included in the paper for increasing client's acceptability and implementation of plant-based diets along with ways to enhance the capacity of health professionals to support the adoption of plant-based diets by individuals with type 2 diabetes.
Coincidentally, the American Academy of Nutrition and Dietetics recently published a position paper on vegetarian diets that also supports plant-based diets for better glycemic control in type 2 diabetes (2).
For your clients, see the new handout on PEN: Plant-based Diet Guidelines
- Rinaldi S, Campbell EE, Fournier J, O'Connor C, Madill J. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes. 2016 Oct;40(5):471-7. doi: 10.1016/j.jcjd.2016.02.011. Epub 2016 Jul 28. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27476051