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Recommendations Summary

DM: Glycemic Index and Glycemic Load (2015)

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: Advise on Glycemic Index and Glycemic Load

    If glycemic index or glycemic load is proposed as a glycemia-lowering strategy, the registered dietitian nutritionist (RDN) can advise adults with diabetes that lowering glycemic index or glycemic load may or may not have a significant effect on glycemic control. Studies longer than 12 weeks report no significant impact of glycemic index or glycemic load, independent of weight loss, on A1C. However, mixed results were reported regarding fasting glucose levels and endogenous insulin levels.

     

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      The recommendation DM: Advise on Glycemic Index and Glycemic Load applies when glycemic index or glycemic load is proposed as a glycemia-lowering strategy.

      Definitions of low-glycemic, medium-glycemic and high-glycemic index or glycemic load diets vary.

    • Potential Costs Associated with Application

      Costs of MNT sessions and reimbursement vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • Studies regarding the relationship of glycemic index (GI), independent of weight loss, reported no significant effect on A1C in adults with type 2 diabetes. However, the differences in GI between interventions were small (Wolever et al, 2008; Cheong et al, 2009; Holub et al, 2009; Turner-McGrievy et al, 2011). Research regarding the relationship of glycemic index on fasting blood glucose reports mixed results (Frost et al, 1994; Wolever et al, 2008; Holub et al, 2009). No studies were identified in adults with type 1 diabetes. Additional long-term studies are needed regarding the relationship of glycemic index on glycemia in adults with diabetes. Grade II
      • Studies regarding the relationship of glycemic index, independent of weight loss, on CVD risk factors reported no significant effect on LDL-cholesterol levels (Frost et al, 1994; Wolever et al, 2008; Holub et al, 2009) or blood pressure (Wolever et al, 2008; Cheong et al, 2009) in adults with type 2 diabetes. However, research regarding glycemic index and total cholesterol, HDL-cholesterol and triglycerides reports mixed results (Frost et al, 1994; Wolever et al, 2008; Holub et al, 2009). Subjects did not have or were not described as having any disorders of lipid metabolism or hypertension, and none of the studies reported on adults with type 1 diabetes. Additional long-term studies are needed to ascertain the relationship of glycemic index, independent of weight loss, on lipid profile in adults with diabetes, especially those with disorders of lipid metabolism and hypertension. Grade III
      • Two studies report mixed results regarding the relationship of glycemic index, independent of weight loss, on endogenous insulin levels in adults with type 2 diabetes (Wolever et al, 2008; Holub et al, 2009). No studies were identified in subjects with type 1 diabetes or that reported on exogenous insulin levels. Additional long-term studies are needed regarding the relationship of glycemic index, independent of weight loss, on insulin levels in adults with diabetes. Grade III
      From the 2013 American Diabetes Association Nutrition Therapy Recommendations

      Substituting low-glycemic load foods for higher-glycemic load foods may modestly improve glycemic control. Grade C

      From the 2015 American Diabetes Association Standards of Medical Care in Diabetes

      Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care and Immunization

      Substituting low glycemic-load foods for higher glycemic-load foods may modestly improve glycemic control. Grade C

    • Recommendation Strength Rationale

      • Conclusion Statements in support of these recommendations were given Grades II and III
      • The 2013 American Diabetes Association Nutrition Therapy Recommendations received Grade C.
      • The 2015 American Diabetes Association Standards of Medical Care in Diabetes received Grade C.

    • Minority Opinions

      Consensus reached.