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Recommendations Summary

DM: Glycemic Index and Diabetes 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  DM: Glycemic Index

  If the use of glycemic index is proposed as a method of meal planning, the RD should advise on the conflicting evidence of effectiveness of this strategy.  Studies comparing high versus low GI diets report mixed effects on A1C. 

  Rating: Fair
  Conditional

  • Risks/Harms of Implementing This Recommendation

    None.

  • Conditions of Application

    None.

  • Potential Costs Associated with Application

    • Although costs of MNT sessions and reimbursement vary, medical nutrition therapy sessions are essential for improved outcomes.

  • Recommendation Narrative

    • Fifteen short-term studies ranging from two to 12 weeks and one longer term (one year) studies report mixed effects on A1C levels (Wolever et al, 1991, 1992, 1994, and 1999; Fontvielle et al, 1992; Frost et al, 1994; Jarvi et al, 1999; Buyken et al, 2001; Gilbertson et al, 2001 and 2003; Helbronn et al, 2002; Kabir et al, 2002; Brand-Miller et al, 2003; Rizkalla et al, 2004; Burani et al, 2006). 
    • These studies are complicated by differing definitions of "high GI" and "low GI" diets or quartiles, as well as possible confounding dietary factors. 

  • Recommendation Strength Rationale

    • Conclusion statement given Grade II.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the relationship between glycemic index and metabolic outcomes in persons with type 1 and type 2 diabetes?

  • References

    Brand-Miller J, Petocz P, Hayne S, Colagiuri S.  Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials.  Diabetes Care 2003; 26:2261-2267.
    
    Burani J, Longo P.  Low glycemic index carbohydrates:  an effective behavioral change for glycemic control and weight management in patients with type 1 and 2 diabetes.  The Diabetes Educator 2006; 32:78-88. 
    
    Buyken AE, Toeller M, Heitkamp G, Karamanos B, Rottiers R, Muggeo M, Fuller JH.  Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids.  Am J clin Nutr 2001; 73:574-581. 
    
    Fontvieille AM, Rizkalla SW, Penfornis A, Acosta M, Bornet FRJ, Slama G.  The use of low glycemic index foods improves metabolic control of diabetic patients over five weeks.  Diabet Med 1992;9(5):444-50.
    
    Frost G, Wilding J, Beecham J.  Dietary advice based on the glycemic index improves dietary profile and metabolic control in type 2 diabetic patients.  Diabet Med 1994;11(4):397-401.
    
    Gilbertson HR, Thorburn AW, Brand-Miller JC, Chondros P, Werther GA. Effect of low-glycemic-index dietary advice on dietary quality and food choice in children with type 1 diabetes.  Am J Clin Nutr 2003; 77:83-90.
    
    Gilbertson HR, Brand-Miller JC, Thorburn AW, Evans S, Chondros P, Werther GA. The effect of flexible low glycemic index dietary advice versus measured carbohydrate exchange diets on glycemic control in children with type 1 diabetes. Diabetes Care. 2001;24:1137-1143.
    
    Heilbronn LK, Noakes M, Clifton PM.  The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control.  J Am Coll Nutr 2002; 21:120-127.
    
    Jarvi AE, Karlstrom BE, Granfeldt YE, Bjorck IE, Asp NGL, Vessby BOH. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low glycemic index diet in type 2 diabetic patients. Diabetes Care. 1999; 22: 10-18.
    
    Kabir M, Oppert JM, Vidal H, Bruzzo F, Fiquet C, Wursch P, Slama G, Rizkalla SW.  Four-week low-glycemic index breakfast with a modest amount of soluble fibers in type 2 diabetic men.  Metabolism 2002; 51:819-826.
    
    Rizkalla SW, Boillot J, Taghrid L, Rigoir A, Laromiguiere M, Elgrably F, Huet D, Slama G.  Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial.  Diabetes Care 2004; 27:1866-1872.
    
    Wolever TMS, Jenkins DJA, Jenkins AL, Josse RG.  The glycemic index:  methodology and clinical implications.  Am J Clin Nutr. 1991;54:846-854.
    
    Wolever TMS, Hamad S, Chiasson JL, Josse RG, Leiter LA, Rodger NW, Ross SA, Ryan EA. Day-to-day consistency in amount and source of carbohydrate intake associated with improved glucose control in type 1 diabetes. J Amer Coll Nutr. 1999;18:242-247.
    
    Wolever TMS, Nguyen PM, Chiasson JL, Hunt JA, Josse RG, Palmason C, Rodger NW, Ross SA, Ryan EA, Tan MH.  Determinants of diet glycemic index calculated retrospectively from diet records of 342 individuals with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1994;59:1265-1269.
    
    Wolever TMS, Jenkins DJA, Vuksan V, Jenkins AL, Buckley GC, Wong GS, Josse RG.  Beneficial effect of a low glycemic index diet in type 2 diabetes.  Diabet Med 1992;9(5):451-8.