Diabetes Developments

ADA: Day 5

San Francisco — For the past five days people with diabetes have taken over downtown San Francisco. More than 20,000 diabetes professionals have been here for the annual meeting of the American Diabetes Association. Those of us wearing ADA name badges not only filled the exhibition halls but also San Francisco’s already crowded sidewalks.

The city was a gracious hostess, providing the best possible accommodations and weather. We met in in the city’s largest convention and exhibition complex, the Moscone Center. Built in 1981, the center is named for George Moscone, a former mayor of San Francisco who was assassinated in 1978.

Moscone Center Entrance

This vibrant city itself explains a lot why for me this was the best ADA ever. It almost tempts me to move back to California and to live in a big city again. But now we are leaving. I tried to stop this bus, but in vain.

Stop the Bus!

It was here a dozen years ago that the ADA introduced us to new terminology describing the types of diabetes. Rather than juvenile or adult-onset diabetes orIDDM or NIDDM, it was in San Francisco that the names Type 1 and Type 2 were born.

This year we have a new term, “estimated average glucose” or the awkward abbreviation by which it is destined to be know, eAG. But this is not just a new term for us to learn but also a concept and measurement to replace the A1C test. For more than a quarter of a century the A1C has been the gold standard of measuring our glucose control.

The eAG is easier for us to use and better than the A1C. It reports our diabetes control in the same units that we use for fingerstick testing, mg/dl in the U.S. or mmol/L in most other countries. The formula for converting our A1C level to eAG is (A1C x 28.7) – 46.7 = eAG. But to make it easier, the ADA made calculators to do the job with a press of the button. They were so popular with the diabetes professionals here that I got the last one the ADA gave away at its booth.

The eAG is news that we will have to use. But the big news that I wanted to use when I read the advance program for this convention was the “current issues” symposium on “The Great Protein Debate.” Being able to listen to this debate was what I anticipated most before coming to San Francisco. And it lived up to expectations.

Actually, only half of the debate met my expectations. That was the talk by Osama Hamdy, MD and PhD, director of the clinical obesity program at the Joslin Clinic in Boston. Dr. Hamdy spoke on “Higher Levels of Protein Intake are Good.” His opponent, Joel Kopple, MD, a professor at the University of California Los Angeles and nephrologist at the Harbor UCLA Medical Center, was off-topic. He failed to address whether a high-protein diet was good or bad for most people with diabetes, focusing on people with kidney disease. Heck, we already knew that if you have kidney disease a high protein diet might not be the way to go.

The bottom line of Dr. Hamdy’s talk is that up to 2 grams of protein per every kilogram of our weight isn’t generally too high. This translates to 140 grams of protein on a 2000-calorie diet, equivalent to 28 percent of calories. Dr.Hamdy says that we don’t have any data yet supporting an increased level of protein above 2 grams per kilogram or 30 percent of our body weight.

I especially liked his slide showing why many of us who have diabetes but no kidney problems may want to increase our protein intake:

Slide courtesy of Dr. Osama Hamdy

After listening with rapt attention to Dr. Hamdy in the packed conference room, I was lucky enough to run into him three times. The first time he posed for this photo:

Dr. Osama Hamdy, Protein and Obesity Expert at the Joslin Clinic
The second time we met I asked his one of the biggest questions in my mind. “But what about the quality of protein?”
“I was just waiting for someone to ask me that,” he replied. He went on to tell me that  two amino acids, lycine and valine, are problematic as they cause dilation of renal vessels and cause the pressure inside the kidney to increase. Non-dairy animal protein has more of these animo acids than vegetable protein does, which is why vegetable protein is better for us. We don’t need to supplement them, but we do need to supplement vegetable protein with other essential amino acids to make them healthier.
Separately, Dr. Hamdy is the lead investigator of a Joslin study presented at this year’s ADA that showed people with diabetes lost an average of 24.6 pounds — 10.3 percent of their body weight — in a 12-week program. This “Weight Achievement and Intensive Treatment (Why WAIT)” program showed that 55 percent of the people in the study continued to lose even more weight for a year afterwards when they were on their own.

A high-protein diet was a big part of the success. Participants in the study ate fewer that 40 percent of their calories from carbohydrates and 30 percent from protein.

I’m hardly surprised. A low-carb high-protein diet works for me to lose weight too.

With high points like listening to and meeting Dr. Hamdy this convention of the ADA completely fulfilled my expectations. And now I somewhat reluctantly depart this exciting meeting and city. Meanwhile, San Francisco is bracing for some other organization to hold its annual convention at theMoscone Center.

This article is based on an earlier version of my article published by HealthCentral.

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