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Old Wed, Mar-06-19, 11:39
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JEY100 JEY100 is offline
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Default Clinician's guide to inpatient LC diets for remission of type 2 diabetes

A clinician's guide to inpatient low carbohydrate diets for remission of type 2 diabetes : toward a standard of care protocol
Mark Cucuzzella*1, Adele Hite2, Kaitlyn Patterson3, Laura Saslow4 & Rory Heath5 sqeE-F8


Type 2 diabetes (T2DM) is most often treated as a chronic progressive condition. However, both clinical experience and scientific studies have shown that remission indicated by a normalizing of blood glucose levels and safe medication reduction through lifestyle change should be considered an achievable clinical outcome for patients with T2DM. Dietary interventions that include therapeutic levels of carbohydrate reduction can be used by clinicians to help patients reach this goal, as evidenced by clinical experience and clinical trials; however, many clinicians and allied healthcare providers have not been trained in how to administer these therapies. This article demonstrates the successful implementation of therapeutic carbohydrate reduction for T2DM in an inpatient setting through the institutional example of a small, rural hospital in the U.S. It provides definitions for therapeutic carbohydrate reduction and a rationale for its use in an inpatient setting in patients who present with T2DM. The article outlines a seven-stage protocol developed from practice-based evidence to be used in an inpatient setting to minimize the requirement for insulin or other hypoglycemic medications and to normalize markers of T2DM in patients with this condition. The protocol consists of: 1) patient selection; 2) pre-diet evaluation and counseling; 3) patient education; 4) initiating the dietary intervention; 5) managing medication changes; 6) addressing any side effects; and 7) follow-up. This protocol serves as an initial framework for developing clinical practice guidelines and a standard of care for using carbohydrate reduction as an intervention for T2DM and related conditions in an inpatient setting. It also indicates the potential for providing clinicians with the opportunity to help patients put T2DM into remission, rather than just manage its progression. A Clinician’s Guide to Inpatient Low-Carbohydrate Diets for Remission of Type 2 Diabetes: Toward a Standard of Care Protocol.


Low-carbohydrate diets are not a new intervention for treatment of T2DM. A textbook published in 1877 indicates that carbohydrate reduction is the preferred treatment for patients with diabetes: “There are few diseases which present to the practitioner so clear an indication of what is to be done...a Diabetic should exclude all saccharine [sugary] and farinaceous [starchy] materials from his diet” [51]. Leading endocrine societies are now rediscovering this treatment. The American Diabetes Association’s (ADA) October 2018 joint position statement with the European Association for the Study of Diabetes (EASD) approved use of a low-carbohydrate diet as Medical Nutrition Therapy (MNT) for adults with T2DM [52]. The ADA’s recently released Standards of Medical Care in Diabetes—2019 includes in its lifestyle management guidance the use of low-carbohydrate diets as nutrition therapy, reflecting the organization’s emphasizes on a patient-centered, individualized approach [53]. The ADA and the EASD both recognize that LCK diets can be a safe, effective way for people diagnosed with T2DM or prediabetes to normalize HbA1c levels while lowering medication therapy, reducing the risk of hypoglycemia or other adverse medication effects, and assisting in weight loss. In this review, we highlight recent trials on the topic but more importantly provide clinicians with guidance for implementing this kind of dietary intervention in their own hospitals or clinics. In providing of a clinical protocol for using a LCK dietary intervention, this article offers the foundations for a shared language for clinicians to use in discussing and comparing interventions, improving protocols, and managing shared concerns. We do not expect this guidance to provide a “one-size-fits-all” approach to care; rather we expect that knowledge gained from the clinical experiences of others will inform a continued improvement in how lowcarbohydrate dietary interventions are used to treat patients. We do, however, anticipate a necessary change in how we discuss the course and treatment of T2DM with patients. With a simple, safe, effective dietary intervention, we can change the conversation around T2DM from one of progression to one of remission.

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