Teaching urban blacks with type 2 diabetes to follow a simple meal plan that emphasizes healthy food choices is as effective in reducing blood-sugar levels as a traditional meal plan that emphasizes smaller portions and weight loss. Also, the healthy food choice (HFC) approach may be easier to teach and easier for patients, especially low-literacy patients, to understand, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09722).
A research team led by researchers from the Emory University School of Medicine randomly assigned 648 patients with type 2 diabetes to receive 6th-grade-level information about either an HFC meal plan or an exchange-based meal plan (EXCH) to compare the impact of these approaches on blood-sugar (glycemic) control, weight loss, serum lipids, and blood pressure 6 months later. The EXCH group was instructed in both food exchanges and portion sizes, and obese patients were assigned meal plans that were 500 kcal below their estimated daily energy requirements. The HFC group received the same educational materials, but all content related to quantity of food was removed. Inserted instead was the FDA's Food Guide Pyramid, which was modified to group high-starch and high-protein foods as recommended for people with diabetes. Patients were instructed to limit use of sweets and fats, particularly saturated fat. Portion sizes were not discussed, and weight loss was not emphasized.
Both groups had similar and significantly improved glycemic control over 6 months: HbA1c decreased from 9.7 to 7.8 percent in the HFC group and from 9.6 to 7.7 in the EXCH group (controlled blood sugar is HbA1c of 7 percent or less). Both groups similarly reduced their intake of fats and sugar-sweetened foods. Weight loss among obese patients was comparable for the two approaches. Improvements in HDL cholesterol and triglycerides were comparable in both groups, while other lipids and blood pressure were not altered.
See "A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes," by David C. Ziemer, M.D., Kathy J. Berkowitz, R.N., F.N.P., C.D.E., Rita M. Panayioto, R.D., L.D., D.C.E., and others, in the June 2003 Diabetes Care 26(6), pp. 1719-1724.