「19/08/07 hiroshi abe

米国糖尿病学会のガイドラインの改定
Standards of Medical Care in Diabetes-2019
は随時更新されています。
更新箇所は注釈として書かれています。元の文章は変更されません。

栄養療法はコンセンサス・レポート発表と同時に、４月１８日に更新されています。
下記からジャンプできます。
https://care.diabetesjournals.org/living-standards

Updates to the Standards of Medical Care in Diabetes
Jump to:
July 31, 2019 Updates (Liraglutide labeling change, Tamborlane et al., REWIND, Battelino et al.)
June 3, 2019 Updates (CREDENCE and CANVAS Trials)
April 18, 2019 Updates (Nutrition Therapy Consensus Statement)
March 27, 2019 Updates (DECLARE-TIMI 5 and REDUCE-IT)
2018 Updates (2018 updates incorporated into the 2019 Standards of Care)

Table 5.1
Medical nutrition therapy recommendations
も更新されており、下記がエビデンスレベルBになっています。

“5.11 A variety of eating patterns are acceptable for the management of type 2 diabetes and prediabetes.
Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for
improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
For select adults with type 2 diabetes not meeting glycemic targets or where reducing glucose-lowering medications is a priority, reducing overall carbohydrate intake with low- or very low carbohydrate eating plans is a viable approach. B”」

こんにちは。
hiroshi abe さんから、
『米国糖尿病学会のガイドラインの改定
Standards of Medical Care in Diabetes-2019は随時更新されています。
更新箇所は注釈として書かれています。元の文章は変更されません。』

とのコメントを頂きました。

ありがとうございます。
https://care.diabetesjournals.org/living-standards
このサイトで
Living Standards of Medical Care in Diabetes（糖尿病医療の現行標準）
が、随時更新されていくということです。
元の文章も残っての随時更新なので、
最新情報がわかりやすいし、どこが変わったのかもわかりやすいし
よい方式と思います。

April 18, 2019 Updates (Nutrition Therapy Consensus Statement) （☆）
栄養療法に関しては、
2019年4月18日が、最新のアップデートです。

hiroshi abe さんにご教示頂いた
英文青字のところの日本語訳が以下です。

「・・・様々な食事パターンが糖尿病のマネジメントにおいて受容できる。・・・

・・・糖尿病の人が、総摂取炭水化物量を減らすことは高血糖を改善することにおいて
最もエビデンスが多いことを実証済みである。
そして個々のニーズや好みに応じた
様々な食事パターンにおいても適用されるかもしれない。
2型糖尿病患者で、血糖コントロール目標を達成していない人や
経口血糖降下薬を減らしたい人は優先する。
総炭水化物摂取量を減らす（低炭水化物または、超低炭水化物）食事パターンは
実行可能な選択肢である。・・・」

ということで、
様々な食事パターンは受容できるとする中で
糖質制限食にエビデンスが最も多いことを述べています。
また他の様々な食事療法にも、糖質制限食を応用することができるかもしれないと
高評価を与えていますので、一安心です。


江部康二

（☆）
5. Lifestyle Management: Standards of Medical Care in Diabetes—2019

Section 5 is updated based on information provided in the ADA document titled: "Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report" per below.

UPDATE: The highlighted paragraph in the section titled: "Eating Patterns, Macronutrient Distribution, and Meal Planning" is updated to state the following: “Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Consider personal preferences (e.g., tradition, culture, religion, health beliefs and goals, economics) as well as metabolic goals when working with individuals to determine the best eating pattern for them (35,51,52). It is important that each member of the health care team be knowledgeable about nutrition therapy principles for people with all types of diabetes and be supportive of their implementation. A variety of eating patterns are acceptable for the management of diabetes (51,54). Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns: 1) emphasize nonstarchy vegetables, 2) minimize added sugars and refined grains, and 3) choose whole foods over highly processed foods to the extent possible (Evert 2019). Referral to an RD or registered dietitian nutritionist (RDN) is essential to assess the overall nutrition status of, and to work collaboratively with, the patient to create a personalized meal plan that considers the individual’s health status, skills, resources, food preferences, and health goals to coordinate and align with the overall treatment plan including physical activity and medication. The Mediterranean-style (55,56), low-carbohydrate (add 2 references) and plant-based (60,61) eating patterns are all examples of healthful eating patterns that have shown positive results in research, but individualized meal planning should focus on personal preferences, needs, and goals. Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences. For individuals with type 2 diabetes not meeting glycemic targets or where reducing glucose-lowering drugs is a priority, reducing overall carbohydrate intake with a low- or very low-carbohydrate eating pattern is a viable option.