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P. B. GEIL, Diabetes Care & Communications, Inc., 937 Turkey Foot Rd., Lexington, KY 40502 Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Over 18.2 million people in the United States now have diabetes, which is associated with serious health complications, premature death and over $132 billion in direct and indirect costs annually in the United States. Controlling diabetes with a combination of lifestyle management, blood glucose monitoring and medication is necessary to reduce complications and costs. Dietary carbohydrates directly affect the blood glucose response. As the search for the best approach to achieving metabolic control continues, the concepts of glycemic response, glycemic index and glycemic load have emerged as an area of lively debate. The glycemic index was initially investigated over twenty years ago as a tool for the nutrition management of type 1 diabetes. Since then, a number of studies have reviewed the effects of glycemic response in both type 1 and type 2 diabetes. While acknowledging that differing food sources of carbohydrate have differing glycemic responses, the American Diabetes Association (ADA) has concluded that the total amount of available carbohydrate in meals or snacks is more important that the source (starch or sugar) or type (low or high glycemic index). Low glycemic index foods may reduce post-prandial hyperglycemia, but persistent concerns about the methodology and evidence from current studies has prevented the ADA from recommending the use of low glycemic index diets as a primary strategy in diabetes food/meal planning. The ADA position is not universal, however, as several international diabetes investigators and associations have endorsed the concept. Key issues in the area of glycemic response and diabetes management include concerns about standardized methodology, the variability of the glycemic response to a food, and the practical aspects of implementing this intriguing approach to diabetes nutrition management.
Session 62, The broad impact of the glycemic response of foods
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