Just Read: A clinician’ s guide to inpatient low-carbohydrate diets for remission of type 2 diabetes

This paper, by Cucuzzella et. al (of all the authors Adele Hite, PhD RD is on Twitter – @ahhite) is a nice review of what’s known about standards of care for initiating low carbohydrate nutrition, especially in the inpatient setting. The appendices also include provider/physician handouts, patient handouts, and a deprescribing guide (since medications usually need to be tapered or removed when reversing diabetes through diet).

The authors make a good point that the inpatient setting is in many ways an ideal place for this intervention:

Specifically, short-acting meal time insulin dosages can usually be discontinued or dramatically decreased, which also serves as a teaching tool for patients regarding effects of dietary carbohydrate on medication use. The disruption of an inpatient hospitalization can also inspire motivation for long-term behavior change.Cucuzzella M, Hite A, Patterson K, Saslow L, Heath R. CASE REVIEW Diabetes Management A clinician’ s guide to inpatient low-carbohydrate diets for remission of type 2 diabetes: toward a standard of care protocol. 2019;9(1):7–19

Besides not ordering sliding scale insulin, the diet order in the hospital is fairly straightforward:

The patient’s dietary order, as an inpatient in the hospital, should be changed to limit carbohydrate intake to 10 g per meal. To increase adherence and reduce perceived hunger, the dietary order may also include instructions to “double eggs, meat, fish, salad and eliminate all sugar/starch and sweet drinks.”Cucuzzella M, Hite A, Patterson K, Saslow L, Heath R. CASE REVIEW Diabetes Management A clinician’ s guide to inpatient low-carbohydrate diets for remission of type 2 diabetes: toward a standard of care protocol. 2019;9(1):7–19

This happens of course after recommended testing, a full history, and physical, which is part of any hospital admission.

The authors note that the intervention can be done as a vegetarian diet, more information about food options are in the paper.

The key point, independent of the types of food consumed, is that focusing on the foods consumed can change the dogma that we were told when we trained, which we now know is wrong.

With a simple, safe, effective dietary intervention, we can change the conversation around T2DM from one of progression to one of remission.Cucuzzella M, Hite A, Patterson K, Saslow L, Heath R. CASE REVIEW Diabetes Management A clinician’ s guide to inpatient low-carbohydrate diets for remission of type 2 diabetes: toward a standard of care protocol. 2019;9(1):7–19

I am privileged to know several of the authors of this paper (and I look forward to meeting the ones I have not met). Mark Cucuzzella, MD (not on Twitter, here’s his facebook page) in my mind is very much a family doctors’s family doctor, in terms of embracing curiosity and looking for the the causes of health rather than treating disease.

Here’s a talk he gave about the work he’s done at West Virginia University:

Declaring a bias I have based on the fact that Mark is also a specialist in sports medicine and gave me the teaching I needed to vanquish achilles tendinitis. It’s what doctors do…

Reference

Cucuzzella M, Hite A, Patterson K, Saslow L, Heath R. CASE REVIEW Diabetes Management A clinician’ s guide to inpatient low-carbohydrate diets for remission of type 2 diabetes: toward a standard of care protocol. 2019;9(1):7–19

Potential Conflicts (as listed)

Laura Saslow’s time was supported, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, K01DK107456, Saslow).

My Disclosures and Conflicts (I have none)

My Disclosures page is here. I’m going to update it in the next few days to declare my personal dietary bias, an important new best practice in these conversations.

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