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Randomised controlled trial
Intensive dietary advice significantly improves HbA(1c) in people with type 2 diabetes who remain hyperglycaemic despite optimised drug treatment
  1. Rhonda C Bell
  1. Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Rhonda C Bell
    Department of Agricultural, Food and Nutritional Sciences, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; rhonda.bell{at}

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Is nutrition therapy for diabetes still part of the ‘first Step’ of treatment?

Pharmacological treatments, once considered ‘second step’ treatments for type 2 diabetes (T2D) after the ‘first step’ of diet therapy and physical activity, have increasingly become part of the first step of treatments.1 Clinical guidelines for diabetes treatment outline the important role that lifestyle plays even after pharmacological treatments have been initiated. However, patients find adherence to appropriate dietary patterns to be one of the most difficult aspects of treatment to implement consistently, and evidence suggests that the recommended dietary patterns are not well followed. Do we really need dietary/nutrition therapy after drug therapy has been initiated?

Coppell and colleagues add to the literature that begins to answer this question. The Lifestyle Over and Above Drugs in Diabetes study examined the extent to which evidence-based dietary advice improved glycaemic control among people with T2D, persistent hyperglycaemia and an optimised drug treatment plan. Volunteers were recruited through media, …

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