Thursday, April 11, 2013
Earlier this week, the Canadian Diabetes Association released the newest version of the Canadian Practice Guidelines for Diabetes.
The online release includes the full text of all 38 chapters and an appendix.
Each chapter comes with a slide set and a brief video highlighting the key recommendations.
The following are the main recommendations for weight management:
- An interdisciplinary weight management program (including a nutritionally balanced, calorie-restricted diet; regular physical activity; education; and counselling) for overweight and obese people with, or at risk for, diabetes should be implemented to prevent weight gain and to achieve and maintain a lower, healthy body weight [Grade A, Level 1A]
- In overweight or obese adults with type 2 diabetes, the effect of antihyperglycemic agents on body weight should be taken into account [Grade D, Consensus].
- Adults with type 2 diabetes and class II or III obesity (BMI ≥35.0 kg/m2) may be considered for bariatric surgery when lifestyle interventions are inadequate in achieving healthy weight goals [Grade B, Level 2]
While the recommendations with regard to pharmacotherapy reflect the lack of effective medications for obesity in Canada, they do highlight the role for bariatric surgery in heavier patients with type 2 diabetes.
There is also a useful checklist for weight management programs:
- The program assesses and treats comorbid conditions.
- The program provides individualized nutritional, exercise and behavioral programs and counselling.
- Nutritional advice is provided by qualified experts (e.g. registered dietitians) and diets are not less than 900 kcal/day.
- Exercise is encouraged but physical activity is promoted at a gradual pace.
- Reasonable weight loss goals are set at 1 to 2 lb/week.
- Cost is not prohibitive, and there are no financial contracts.
- There is no requirement to buy products, supplements, vitamins or injections.
- The program does not make unsubstantiated claims.
- The program has an established maintenance program.