For years, diabetics have been instructed to avoid sucrose and foods containing sucrose. The reason behind this recommendation was to promote normal glycemia as it was believed that consumption of sucrose and sucrose-containing foods would promote hyperglycemia and hyperlipidemia. However, in recent years, consuming a moderate amount of dietary sucrose, within a balanced meal, has been shown to have a similar effect on glycemic control as does the consumption of starch. As a result of this research, leading diabetic organizations across the world now advise that moderate consumption of sucrose (up to 10% of daily calories) can be included in a healthy diabetic meal plan if adjustments in other carbohydrate choices are made. Despite these recommendations, health care providers have been reluctant to "permit" their patients to eat sucrose-containing foods. It is thought that this is due to the fear that teaching free-living patients the new sugar guidelines will result in deterioration of eating habits and metabolic profile if the guidelines are misinterpreted and/or misapplied.
Recently researchers set out to determine the consequences on dietary habits, metabolic control, and perceived quality of life of teaching free-living subjects with type 2 diabetes how to use and integrate the new "sugar guidelines." An eight-month randomized controlled trial was performed and consisted of a nutrition education program. During the first four months of the study, all subjects were taught by a dietitian a conventional meal plan to meet the goals of medical nutrition therapy and were advised to avoid concentrated sweets, i.e., foods containing sucrose. At the four-month visit, subjects were randomized to either the conventional (C) group, where they continued the same conventional meal plan, or the sugar (S) group, where they were taught how to use and incorporate the sugar choices into their diet plan.
Forty-eight free-living type 2 diabetic men and women comprised the subjects. The subjects had no specific dietary restrictions, other than for diabetes, and had never received formal training on how to incorporate the new sugar guidelines into their diets. Subjects were excluded from the study if they had abnormal lipid profiles. They were followed closely at follow-up visits with both an endocrinologist and the dietitian every two months.
Researchers obtained an average of six random 24-hour recalls during the four-month baseline period and another six recalls following the randomization. A dietitian performed nutrient analyses on all recalls. Fasting blood samples were collected at entry and every two months. Body weight was recorded at every visit. Patients were also provided with a glucometer and instructed to measure their blood glucose according to a predetermined schedule. Quality of life was measured using the Medical Outcome Survey (MOS) and the Diabetes Quality of Life (DQOL) measures, which were completed at entry, at randomization, and at the end of the study.
The results revealed that the S group did not consume more calories and actually were found to eat significantly less carbohydrate and less starch then the C group. Weight remained stable between the two groups. There were also no significant differences in metabolic profile or perceived quality of life between the two groups.
Allowing individuals with type 2 diabetes to include sugar in their daily eating routines showed no negative impact on their dietary habits or metabolic control. The researchers suggest that health professionals can be reassured and encouraged to teach these new "sugar guidelines" to their patients. However, this study was performed with a small group of subjects who were very closely monitored and given frequent reinforcement. Further research is needed in larger, more diverse groups to determine the impact that promoting these new recommendations have on the health and glycemic control of type 2 diabetics.
J. Nadeau, K. Koski, I. Strychar, et al. Teaching subjects with type 2 diabetes how to incorporate sugar choices into their daily meal plan promotes dietary, compliance and does not deteriorate metabolic profile. Diabetes Care;24:222-227 (February, 2001) [Correspondence: Jean-Francois Yale, MD. McGill Nutrition and Food Science Centre, Royal Victoria Hospital, 687 Pine Ave. West, Montreal, PQ, Canada H3A 1A1. E-mail: yale@ryhmed.lan.mcgill.ca.]
COPYRIGHT 2001 Technical Insights, a divison of John Wiley & Sons.
COPYRIGHT 2001 Gale Group
