Imperfect dieting is a major cause of the progressive nature (i.e. inevitably getting worse) of diabetes.  Due to insufficient understanding of diabetes, patients when diagnosed cannot receive the information necessary to reliably control their diabetes by diet-and-exercise-alone.  This shortcoming speeds progression of their diabetes into medication (e.g. one tablet, tablets, then insulin) and diabetic complications.  These diabetic complications are mainly: coronary heart disease (CHD, from which about 80% of diabetics die prematurely in developed countries), stroke, blindness, kidney failure, lower leg amputation, impotence, and other general nerve damage.  Accelerated mental decline and Alzheimer's disease also occur with poorly controlled diabetes.

The DiabeticOptiCarbDiet (DOCD) was created by a Type 2 diabetic (Dr Roger Grant - a scientific PhD, with a GP doctor wife; more background in footnote), initially just for his own preservation and to allow him to continue enjoying food.  Soon after diagnosis, he realized some deficiences in existing diet-and-exercise-alone BG control advice.  Mainly among these, a reasonable understanding of the qualitative aspects of control (e.g. healthy and unhealthy nutrients and foods) was undermined by casual approaches to defining the quantitative control aspects (e.g. suitable carb weights).  This in spite of the fact that the amount of carb eaten is known to be a strong influence on postprandial BG level.  His many structured eating tests on his own body, over 5 years, produced the "major research breakthrough" outlined in the SUMMARY above.  He finished up with all the information he needed at diagnosis - had it existed.  Subsequent piloting by medical professionals plus diabetic users' feedback, over nearly 3 years, showed DOCD to be individually applicable to other Type 2 diabetics.  In other words, DOCD provides each person with their own safe maximum individual food weights, according to their diabetic severity, etc.

As the creator of DOCD, Roger is its longest beneficiary.  It has kept him free from complications and medication for over 10 years.  This is good by any standards, particularly in view of his DOCD evaluation indicating a high extent of beta-cell exhaustion at diagnosis (i.e. his pancreas can produce little insulin).  This 10 years span gives an idea of the potentially greater duration over which DOCD should protect both pre-diabetics, and diabetics who have less severe beta-cell exhaustion and whose body has not been used as a guinea pig over the previous decade.

One main measure of DOCD's performance, is its having held Roger's 6-monthly DCCT-aligned HbA1c* test values in the narrow range of 6.2-7.3% since early 2001 (when the test method was revised), after an equivalent value at diagnosis of 8.6%.
* HbA1c is the percentage of glucose attached to the blood's hemoglobin, and so a measure of BG level - both averaged over the previous 2 to 3 months.  An HbA1c value, obtained by following DOCD, is more complications-protective than the same HbA1c recommended target value (e.g. ADA's less than 7.0%).  This results from such targets being concluded from the HbA1c levels at which large numbers of diabetics on medication start to develop complications.  Diabetics on medication can get (sometimes dangerously) low ("hypoglycemic") BG levels.  Averaging BG values results in these low BG values partly offsetting the high ("hyperglycemic") damaging BG values.  So the damaging high BG levels are not adequately reflected by the (average) HbA1c value.  By contrast, DOCD consistently avoids these high damaging BG levels, and people controlling by diet-and-exercise-alone do not normally drop to low hypoglycemic levels.

When DOCD was first made available in 2004, it was well ahead of present (i.e. 2008) published literature on diet-and-exercise-alone BG control.  This is shown by a recent comprehensive literature review of the subject.  Greatest interest in the original OptimumCarbDiet (OCD) came from General Practice (i.e. primary care) level, and from diabetics disillusioned with their own primary care's advice.  In reality, both were looking for an approach that really worked.  For General Practitioners, in the UK and elsewhere, the 10 minutes usually available for each patient ruled out providing the explanations necessary for OCD.  Between this, and other findings from nearly 3 years of piloting OCD and DietControlDiabetes, it was decided to completely rewrite these files.  So DOCD was written at the simplest level possible (i.e. essentially DIY - Do It Yourself, with considerable detailed self-help guidance) without reducing its effectiveness.  That way, those following DOCD independently, have reduced need for their medical professional's time - but should consult them if in any medical doubt.  DOCD's printouts are equally designed to be given to patients by primary care medical professionals.  Roger Grant provides help to both independent users and medical professional users of DOCD.

Because DOCD deals with quantities more than other diets, it is only suitable for those who are comfortable with elementary math(s) and at least moderately persevering when learning more about a familiar subject.  Usually this perseverance is supported by enthusiasm - when the DOCD user sees their existing queries being answered by realistic solutions, and improvements soon becoming visible.  At present these people are confined to inadequate primary care approaches - and therefore largely condemned to BG control failure, subsequent medication, and possible complications.  By contrast, DOCD offers an alternative approach that can enable them to both improve and maintain their health for significantly longer.  DOCD could be followed by a larger proportion of pre-diabetics and diabetics if it was introduced and supported by diabetic education.

THE TWO MAIN REASONS BEHIND DOCD’S EFFECTIVENESS
DOCD's superior effectiveness in delaying the onset of complications - probably longer than any other diet-and-exercise-alone approach - results mainly from the "major research breakthrough" mentioned in the SUMMARY above.  The following outlines how DOCD's breakthrough put it ahead of other common diets:

1. THE BREAKTHROUGH.  Macrovascular (ie: large artery) damage, which leads to CHD and stroke, has usually been present for some years when Type 2 diabetes is diagnosed.  If BG level is not well controlled, microvascular (ie: small artery) damage follows, and this leads to the other 5 complications listed in the first paragraph.  High BG levels also aggravate existing macrovascular damage.  So DOCD is principally aimed at always keeping BG level below the levels at which the artery damage causing complications occurs.
   Each time a person eats carb, their BG level rises to a postprandial (i.e. after eating) peak, and then decreases.  In non-diabetics, these BG peaks go up to about 10.0 mmol/L (180 mg/dL).  In diabetics, the high BG damage causing complications is believed to result during time spent above this 10 mmol/L level.  In the diagram, the colour intensity represents the likelihood of a diabetic's peaks occurring in the safe lower BG region (green) or in the upper region where the complications damage occurs (red) - according to the diet being followed.  The size of the red arrows represents the relative height above 13 mmol/L (234 mg/dL) to which these peaks may rise.  So:
   
   • ONE SIZE FITS ALL DIETS, which include most diets (particularly book and Web information), do not delay complications and medication for long.  This is due to the food weights suggested usually being unrelated to the individual's ability to metabolize and store carb.  "One Size Fits Few" would be a truer description.  This is simplified in the diagram as just two, of many, possibilities.
     
   • STARCHY FOOD-BASED DIETS.  The diabetic institutions (ADA, etc) recommended such dieting, with carb providing 40-60% of daily energy intake, so as to limit diabetics' unfriendly fats intake and be heart- and blood pressure-friendly over the long term.  (DOCD follows this basis too; 40% is from Joslin Center).  However Exchanges, Carb Counting, the Food Pyramid, MyPyramid, etc, are insufficiently individually precise to prevent damaging high BG levels.  This led to the creation of a multiplicity of alternative diets.
     
   • LOW-CARB DIETS (e.g. Atkins) are one such type of alternative diet.  They achieve low BG peak values by eating small weights of carb, but this means more calories have to come from fats and protein.  So such diets do not usually meet the long-term heart- and blood pressure-friendly nutrient limits recommended by the diabetic institutions.
     
   • LOW GLYCEMIC INDEX (GI) AND LOW GLYCEMIC LOAD DIETS may reduce BG peak level somewhat, relative to the user's previous control method - but will not exercise sufficient food weight control.  DOCD is significantly more powerful , because it takes GI and GL into problem-solving new territory.
     
   • DIABETICOPTICARBDIET (DOCD).  The safest way to control BG peak level is to eat weight(s) of food that will not raise this peak to the region where damage occurs.  This means peaks normally not higher than 9.0 mmol/L (162 mg/dL) and rarely spending time above 10.0 mmol/L (180 mg/dL).  Lower upper limits are possible - providing the diabetic is capable of an adequate eating BG range (e.g. 5.0 to 8.0 mmol/L).  DOCD provides this food weight limit, according to the individual diabetic's personal severity, etc, for any food or food combination.  (Food combinations have hitherto also been an unconquerable obstacle in the harnessing of GI).  Those who subsequently need medication, should obtain greater benefit from it as a result of their DOCD education.
   
   

2. THE SUBSEQUENT REFINEMENTS.  So long as there was no good workable approach to control BG, it was not possible to detect accompanying minor refinements, because the variation in results was too great.  After the above breakthrough, many hitherto unknown refinements became apparent.  While individually they influence BG control less than food weight, collectively they give DOCD much more effective strategies.  A major factor in the success of the initial research was its being done by a non-medical Type 2 diabetic continuously experimenting on himself, while keeping an open mind and needing to understand what was going on.  It is clear, when talking to new DOCD users, that this understanding has given them a quantum leap in grasping what was previously an overly mysterious subject.