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Exchange system This system is based on the classification of the main food groups: carbohydrates (starches, fruit, milk, vegetables), meat and fish (proteins) and fat. Food tables are provided which include the proportion for 100 g of the different active principles. The food with similar nutrient values are numbered together and these can be exchanged for any other belonging to the same list. The common portions of each food are numbered, including its weight in grams. The exchange lists are used to achieve an appropriate nutrient contribution and provide a variety when planning the meals. An SR (82) compared the effectiveness of the exchange diets in contrast to a standard diet with low fat reduction. No conclusion was established due to the lack of evidence available. In an RCT not included in the SR no differences were found between the exchange diet recommended by the ADA and a weekly planned diet. Both improved weight loss, glycemic control and the lipid profile (96). The CPG recommends the mid-night snack to avoid night hypoglycaemia in patients on pharmacological treatment (79), though no studies have been found on this issue. SR of RCT 1+ RCT 1+ Expert opinion 4 Evidence summary 1+ Dietary changes, exercise and behavioural therapies are effective in DM 2 weight loss and glycemic control. Their combination increases efficacy (73; 82). 1+ Diets with high amount of fibre and a 55% to 60% of carbohydrates are more efficient for glycemic control than the diets with moderate amounts of carbohydrates (30%-54%) and a low or moderate amount of fibre (81). 1+ Diets based on food with low glycemic indexes show a favourable tendency in glycemic control (81). 1+ Diets where the amount of fat consists of polyunsaturated fatty acids improve the lipid profile in diabetic patients (91). 1+ Drugs for obesity (orlistat, sibutramine, rimonabant) are effective for weight loss and improve glycemic control. Nevertheless, the frequent or potentially severe adverse effects limit their use (83; 87). Sibutramine can provoke adverse effects at cardiovascular level (83). Rimonabant has been withdrawn form the market. 1+/2+/3 Surgical treatment for DM 2 patients and those with morbid obesity is effective to reduce weight and to improve the glycemic profile in specific cases (88). 1+ Omega 3 fatty acid supplements reduce triglycerides and produce a slight increase in LDL levels (92). 2+ Moderate alcohol intake is associated with a reduction of cardiovascular morbimortality risk without presenting any effect on glycemic control (36; 93). 4 There are several useful systems to plan diets (based on meals, guidelines, carbohydrates count, exchange). Their effectiveness has not been compared (79). 56 CLINICAL PRACTICE GUIDELINES IN THE NHS
Recommendations D A B B B C B D The carbohydrate intake should be distributed throughout the day in order to maintain glycemic control, adjusting it to pharmacological treatment. Structured programs which combine physical exercise with dietary guidance, fat intake reduction (
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Clinical Practice Guideline on type
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A bibliographic record of this work
Page 7 and 8: Table of Contents Presentation 9 Au
Page 9 and 10: 11. Diabetic foot. Assessment, prev
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Page 14 and 15: Other collaborations Rosa Rico Itur
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Page 19 and 20: Summary of recommendations Defi nit
Page 21 and 22: D CPG B B B B A daily single dose
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Page 25 and 26: Treatment for diabetic foot ulcers
Page 27: 1. Introduction Effective care for
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11.5.4. Antibiotic treatment for in
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2+ The culture has a limited value
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• Promote healthy lifestyles: die
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In another recent RCT (289), sMBG w
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12.3. Contents and methods of an ed
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Assessment of self-management recor
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13.4. Referral criteria to medical
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Appendices Appendix 1. Levels of Ev
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Appendix 2. DM 2 diet Estimating ca
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CLINICAL PRACTICE GUIDELINE ON TYPE
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GPL-1 Analogues Biguanides Glitazon
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Devices FLEXPEN (Novo Nordisk): OPT
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Treatment for an unconscious patien
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Appendix 6. Assessment of macro- an
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Appendix 8. Use of monofilament Mon
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Indicators of final outcomes • Nu
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Impaired Glucose Tolerance (IGT): I
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IGT INSIGHT Trial IV LDL LH LIFE Tr
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Bibliography 1. Estrategia en diabe
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33. Iso H, Date C, Wakai K, Fukui M
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64. Screening for type 2 diabetes.
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97. Thomas DE, Elliott EJ, Naughton
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129. Lincoff AM, Wolski K, Nicholls
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157. Natarajan S, Liao Y, Cao G, Li
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185. de GG. Low-dose aspirin and vi
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214. Rahman M, Pressel S, Davis BR,
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245. NZGG. Management of type 2 dia
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279. Norris SL, Nichols PJ, Caspers
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