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.