My Items

Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed ”remission“ as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
https://care.diabetesjournals.org/content/early/2021/08/17/dci21-0034

These guidelines provide clinicians with a general protocol for implementing therapeutic carbohydrate restriction as a dietary intervention in hospitals or clinics. These guidelines are meant to be applied as a dietary intervention for specific conditions for which carbohydrate reduction has been shown to offer therapeutic benefits. For the full information click on the below link https://www.metabolicpractitioners.org/clinical-guidelines/ http://www.metabolicpractitioners.org/wp-content/uploads/2020/10/Clinical-Guidelines-General-Intervention-v1.3.8.pdf

Position Statement of Diabetes Australia endorses Low Carbohydrate eating for people with Diabetes Diabetes Australia:- "There are 1.7 million Australians living with all types of diabetes and every person is unique. That means everyone manages their diabetes in slightly different ways. "One part of living with diabetes everyone has to think about is what they eat. We believe there is no one-size-fits-all approach to food and diabetes and that’s why people should talk to a qualified health professional to develop an approach that suits them. "For many people in Australia’s diabetes community that means adopting a low carb approach. We acknowledge that a low carb approach can be great for some people and we support people who choose to do this. That’s why we developed a position statement to help people make an informed decision about what is best for them. "The Australian Dietary Guidelines are a good starting point for all Australians, but we always recommend that people with diabetes talk to their diabetes healthcare team and get *individualised advice* "The Guidelines are now seven years old and there has been plenty of new research since then. We are pleased the NHMRC has announced a review of the Guidelines, taking into account the best available evidence from leading experts "Diabetes Australia will be contributing to ensure we get the best possible dietary guidelines for people with diabetes." Full Text PDF in the below link: https://www.diabetesaustralia.com.au/wp-content/uploads/Diabetes-Australia-Position-Statement-Low-Carb-Eating.pdf

Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis Published: 30 November 2020 Results After KD intervention, in terms of glycemic control, the level of fasting blood glucose decreased by 1.29 mmol/L (95% CI: −1.78 to −0.79) on average, and glycated hemoglobin A1c by 1.07 (95% CI: −1.37 to −0.78). As for lipid metabolism, triglyceride was decreased by 0.72 (95% CI: −1.01 to −0.43) on average, total cholesterol by 0.33 (95% CI: −0.66 to −0.01), and low-density lipoprotein by 0.05 (95% CI: −0.25 to −0.15); yet, high-density lipoprotein increased by 0.14 (95% CI: 0.03−0.25). In addition, patients’ weight decreased by 8.66 (95% CI: −11.40 to −5.92), waist circumference by 9.17 (95% CI: −10.67 to −7.66), and BMI by 3.13 (95% CI: −3.31 to −2.95). Conclusion KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss. Link to Full text: https://www.nature.com/articles/s41387-020-00142-z?utm_source=nutd_etoc&utm_medium=email&utm_campaign=toc_41387_10_1&utm_content=20201201&sap-outbound-id=E49535A68D577B79C13E037DAB8CC7A118ABDE72FL&fbclid=IwAR3uEgw0uAUgoZXp5cNAfhc_FqPapdQ80is3Tv8-XCB9aKJquR3cMjEygb0&s=08

Published: December, 2020 Scientists continue to explore the right balance of carbohydrates and fat in people's diets. But for overweight or obese older adults, a recent study found that a low-carbohydrate, high-fat diet might offer special health benefits. The results were published online Aug. 12, 2020, by Nutrition and Metabolism . Researchers asked 40 obese adults, ages 60 to 75, to follow an eight-week diet in which 10% of calories came from carbs, 25% from protein, and 65% from fat. Carb sources included leafy greens, non-starchy vegetables, some fruit, and high-fiber grains. Protein intake consisted of eggs, fish, pork, and poultry. Fat-containing foods included olive oil, coconut oil, nut oils, nut butter, cheese, coconut milk, and avocados. Compared with a control group, the low-carb, high-fat group lost more visceral fat (the deep hidden fat surrounding abdominal organs). They also had a big drop in insulin resistance and improved their cholesterol levels. These changes are linked with a lower risk of stroke, diabetes, and heart disease. While this diet's long-term benefits are unknown, reducing carb intake could be a way for older adults to jump-start their weight-loss efforts and improve their health in ways that the scale does not always show. Link: https://www.health.harvard.edu/staying-healthy/low-carb-and-high-fat-diet-helps-obese-older-adults?s=08

The 2020 Obesity Algorithm is an essential tool for any practice; it contains updated information on the mechanisms, evaluation, and treatment of obesity, including why obesity is a disease, how obesity causes the most common metabolic diseases encountered in clinical practice, and how to treat obesity to reduce disease risk. This year’s update to the Obesity Algorithm includes many features to make the tool more applicable in clinical practice, such as a snapshot of “Top 10 takeaway messages” in each section for quick reference; scientific evidence to dispel common misrepresentations and “myths” about the disease of obesity; and updated links to multimedia educational resources. Other updates include: Adiposopathic aging Polycystic ovary syndrome Ketogenic diet Obesity and psychiatry Table of anti-obesity agents in development The role of gastrointestinal hormones in energy and nutrient regulation Updates to bariatric surgery nutrient replacement Over 800 new and updated references https://obesitymedicine.org/obesity-algorithm/ https://obesitymedicine.org/download-obesity-medicine-resources/

Recommendations 1. Individuals with diabetes should be supported to choose healthy eating patterns that are consistent with the individual’s values, goals and preferences. 2. Healthy* low or very-low-CHO diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved glycemic control and/or to reduce the need for antihyperglycemic therapies. Individuals should consult with their health-care provider to define goals and reduce the likelihood of adverse effects. 3. Health-care providers can support people with diabetes who wish to follow a low-CHO diet by recommending enhanced blood glucose monitoring, adjusting medications that may cause hypoglycemia (sulfonylureas and insulin), or increase risk for DKA (SGLT2 inhibitors, underdosing insulin in those with insulin deficiency), and to ensure adequate intake of fibre and nutrients. 4. Individuals and their health-care providers should be educated about the risk of euglycemic DKA while using SGLT2 inhibitors and low-CHO diet, and further educated about the strategies to mitigate this risk (33).2 5. People with diabetes who begin a low-CHO diet should seek support from a dietitian who can help create a culturally appropriate, enjoyable and sustainable plan. A dietitian can propose ways to modify CHO intake that best aligns with an individual’s values, preferences, needs and treatment goals as people transition to or from a low-CHO eating pattern. https://www.canadianjournalofdiabetes.com/article/S1499-2671(20)30097-6/pdf https://www.canadianjournalofdiabetes.com/article/S1499-2671(20)30097-6/fulltext

Low Carbohydrate Diet (LCD) & Very Low Carbohydrate Diet (VLCD) in ADA Guidelines ADA in its Apr’19 consensus recommends that people with diabetes be offered individualized medical nutrition therapy, rather than be given the “one-size-fits-all” advice to count carbohydrates and restrict calories. Included in options that should be offered to patients are low carbohydrate diet (LCD) & Very Low carbohydrate diet (VLCD). The LCD includes the intake of 26-45% of total daily calories as carbohydrate& very low carbohydrate diet eating pattern of 20-50 g carbs per day. The report also includes the statement “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences.” They have emphasised the benefits as below: A1c Reduction Weight Loss Lowered Blood Pressure Increased HDL-C & Lowered Triglycerides Full Text from below link: https://care.diabetesjournals.org/content/diacare/early/2019/04/10/dci19-0014.full.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899840/?s=08 Abstract Purpose of review
This review will examine advances in our understanding of the role kidneys play in HDL metabolism and the effect on levels, composition, and function of HDL particles.
Recent findings
Components of the HDL particles can cross the glomerular filtration barrier. Some of these components, including apolipoproteins and enzymes involved in lipid metabolism, are taken up by the proximal tubule and degraded, modified, salvaged/returned to the circulation, or lost in the urine. Injury of the glomerular capillaries or tubules can affect these intrarenal processes and modify HDL. Changes in the plasma and urine levels of HDL may be novel markers of kidney damage and/or mechanism(s) of kidney disease.
Summary
The kidneys have a significant role in metabolism of individual HDL components, which in turn modulate HDL levels, composition and functionality of HDL particles. These intrarenal effects may be useful markers of kidney damage and have consequences on kidney-related perturbations in HDL. Simple Explanation: HDL and its constituent parts can be lost through the kidney. So if microalbuminuria is present you can be losing the most important lipoprotein 😨. No wonder diabetics and those with CKD gets so much CVD 🥴