The American Association of Clinical Endocrinologists has created a document and flowchart to guide health professionals in treating diabetic patients. The first official recommended treatment is always lifestyle modification. The next series of steps are a continual progression of increasing medications recommended to keep the A1c within target range, starting with metformin, then proceeding to dual oral therapy, then triple oral therapy and then insulin.

[7] American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE). 2015. “AACE/ACE Comprehensive Diabetes Management Algorithm.” Accessed at https://www.aace.com/files/aace_algorithm.pdf. April.

A similar guide by the National Institute for Health and Care Excellence (NICE) in the U.K. is a flow chart to guide health professionals in treating diabetic patients. Topics covered include determining appropriate HbA1c targets based on individual needs and preferences; guidance on possible treatment with medication; and action steps to follow when using insulin-based treatment. It again shows the continual progression of increasing medications, multi-medication therapy, and then insulin.

[8] National Institute for Health and Care Excellence (NICE). 2015.”Algorithm for Blood Glucose Lowering Therapy in Adults with Type 2 Diabetes.” Accessed at https://www.nice.org.uk/guidance/ng28/resources/algorithm-for-blood-glucose-lowering-therapy-in-adults-with-type-2-diabetes-2185604173. December.

The American Heart Association reports that adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.[1] And according to the National Institutes of Health, even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure; 43% of kidney failure is due to diabetes.[2] Sitting in a dialysis unit four hours a day several times a week is not how most retired people would want to spend their golden years. Blindness, neuropathy and amputation are the next series of risks, among others. [3]

[1] American Heart Association. 2016. “Cardiovascular Disease & Diabetes.” Accessed at https://www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/. Page last updated November 4, 2016.

[2] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2017. “Diabetic Kidney Disease: What is Diabetic Kidney Disease?” Accessed at https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease. Page last updated February 2017.

[3] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2017. “Preventing Diabetes Problems.” Accessed at https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems.

One out of every eight Americans consumes less than the recommended servings of vegetables per day, and 75% consume less than the recommended amount of fruit per day – while at the same time most of them are trying to improve their eating habits.[4],[5] And the latest 2017 guidelines by the American Diabetes Association confirm the benefit of using vegetables, fruits, beans, and other plant centered foods as a recommended dietary pattern, so there is no debate about the benefit of these lifestyle modifications. [6] However research studies show implementing them is not easy. Could it be that many people fail because they find doing their own taxes easier than improving their diet and health? [5]

[4] USDA & HHS. 2015. “Dietary Guidelines for Americans, 2015-2020. Eighth Edition.” Accessed at https://health.gov/dietaryguidelines/2015/guidelines/.

[5] Foodinsight.org. 2012. “2012 Food & Health Survey.” Accessed at https://www.foodinsight.org/2012_Food_Health_Survey_Consumer_Attitudes_toward_Food_Safety_Nutrition_and_Health. Page last updated April 11, 2016.

[6] American Diabetes Association. 2017. “Standards of Medical Care in Diabetes – 2017.” Accessed at https://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf. January.