Diabetic Diet Research Papers - Academia.edu (original) (raw)

- by
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- Health Behavior, Malaysia, Life Style, Physical Activity

Objectives. Current evidence shows that type 2 diabetes (T2D) can be prevented by lifestyle changes and medication. To meet the menacing diabetes epidemic, there is an urgent need to translate the scientific evidence regarding prevention of T2D into daily clinical practice and public health. In Finland, a national programme for the prevention of T2D has been launched. The programme comprises 3 concurrent strategies for prevention: the population strategy, the high-risk strategy and the strategy of early diagnosis and management. The article describes the implementation strategy for the prevention programme for T2D. Methods. The implementation project, FIN-D2D, is being conducted in 5 hospital districts, covering a population of 1.5 million, during the years 2003-2007. The main actors in the FIN-D2D are primary and occupational health care providers. Results. The goals of the project are (1) to reduce the incidence and prevalence of T2D and prevalence of cardiovascular risk factor levels; (2) to identify individuals who are unaware of their T2D; (3) to generate regional and local models and programmes for the prevention of T2D; (4) to evaluate the effectiveness, feasibility and costs of the programme; and (5) to increase the awareness of T2D and its risk factors in the population and to support the population strategy of

- by S. Keinänen-kiukaanniemi
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- Health Behavior, Life Style, Adolescent, Finland

Aim: The aim of this paper is to explore Norwegian health workers' experiences from cross-cultural patient encounters, and how they understand and enact their role when meeting patients with Pakistani background to whom they give dietary advice related to type 2 diabetes. Methods: Qualitative in-depth interviews have been performed with six hospital dietitians and six general practitioners in Oslo. Results: The health workers consider themselves to be patient-centred and stress the importance of the two dimensions, empathy and equality. However, they often experience that patients want them to be more authoritarian, a way of acting that would be totally in disagreement with their convictions, although some occasionally do adopt an authoritarian style. More striking is that some health workers' moral engagement to involve and empower patients actually leads them to be authoritarian. For others, a fear of insulting the patient results in their advice being too diffuse. Conclusions: A possible explanation for such ways of responding to the patient may be that the health workers, in their articulation of patient-centredness, draw on a repertoire of social conduct that involves an effort to level out, or tacitly deny, hierarchic structures, and that this becomes more pronounced in cross-cultural encounters. Patient-centredness and empowerment are results of long ongoing processes in Western countries, based on ideals of equality and individual freedom. The results from this study indicate that these approaches may pose intricate dilemmas for the health workers in their cross-cultural encounters, and need further attention.

- by Marianne Lien
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- Pakistan, Family Practice, Empathy, Norway

We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus. Women with gestational diabetes mellitus (N = 19) were randomized into either group I, a 6-week diet alone group (24 to 30 kcal/kg/24 hours; 20% protein, 40% carbohydrate, 40% fat), or group II, which followed the same diet plus exercise (20 minutes three times a week for 6 weeks). An arm ergometer was used to maintain heart rate in the training range. Glycemic response was monitored by glycosylated hemoglobin, a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose, and blood glucose selfmonitoring, fasting and 1 hour after meals. Week 1 glycemic parameters were the same for both groups.

- by Eric Durak
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- Exercise therapy, Gestational diabetes, Pregnancy, Blood Glucose

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and
Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary
change, and the social and cultural factors informing their accounts.
Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with
type 2 diabetes. Respondents were interviewed in their first language (Punjabi or
English) by a bilingual researcher. Data collection and analysis took place
concurrently with issues identified in early interviews being used to inform areas of
investigation in later ones.
Results. Despite considerable diversity in the dietary advice received, respondents offered
similar accounts of their food and eating practices following diagnosis. Most had
continued to consume South Asian foods, especially in the evenings, despite their
perceived concerns that these foods could be ‘dangerous’ and detrimental to their
diabetes control. Respondents described such foods as ‘strength-giving’, and highlighted
a cultural expectation to participate in acts of commensality with family/community
members. Male respondents often reported limited input into food preparation. Many
respondents attempted to balance the perceived risks of eating South Asian foodstuffs
against those of alienating themselves from their culture and community by eating such
foods in smaller amounts. This strategy could lead to a lack of satiation and is not
recommended in current dietary guidelines.
Conclusions. Perceptions that South Asian foodstuffs necessarily comprise ‘risky’ options
need to be tackled amongst patients and possibly their healthcare providers. To enable
Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines
should promote changes which work with their current food practices and preferences;
specifically through lower fat recipes for commonly consumed dishes. Information and
advice should be targeted at those responsible for food preparation, not just the person
with diabetes. Community initiatives, emphasising the importance of healthy eating, are
also needed.
Keywords: food; diet; identity; type 2 diabetes; Pakistani; Indian

- by Lisa Hanna and +2
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- Sociology, Cognitive Science, Pakistan, Ethnicity And Health

Background Although vegan diets improve diabetes management, little is known about the nutrient profiles or diet quality of individuals with type 2 diabetes who adopt a vegan diet. Objective To assess the changes in nutrient intake and dietary quality among participants following a low-fat vegan diet or the 2003 American Diabetes Association dietary recommendations.

The determine the effect of different foods on the blood glucose, 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers. Blood glucose levels were measured over 2 h, and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose. The largest rises were seen with vegetables (70 +/- 5%), followed by breakfast cereals (65 +/- 5%), cereals and biscuits (60 +/- 3%), fruit (50 +/- 5%), dairy products (35 +/- 1%), and dried legumes (31 +/- 3%). A significant negative relationship was seen between fat (p less than 0.01) and protein (p less than 0.001) and postprandial glucose rise but not with fiber or sugar content.

- by Alexandra Jenkins
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- Engineering, Diet, Food Analysis, Blood Glucose

Carbohydrate (Carb) counting is a meal planning approach for patients with diabetes mellitus that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carb counting is not new. In the early 1990's the Diabetes Control and Complications Trial (DCCT) used carb counting as one of its education tools. More recently, short acting insulin analogues and insulin pumps have made the role of carb counting important and popular. Carb counting can be used in conjunction with a meal plan to set carbohydrate targets at each meal and snack. It is also used, perhaps more commonly, to estimate carbohydrate intake and adjust insulin around mixed meals and snacks using insulin to carbohydrate ratio. This effectively addresses the variable eating habits of most children and adolescents. The method may be adapted for patients who use a conventional insulin regimen and may meet the needs of patients who use multiple daily injections (MDI) or an insulin pump. Carb counting can make food planning flexible and enjoyable for patients, and the meal planning approach is very important for the physical growth and psychological development of children with diabetes. This paper describes the importance of carb counting for childhood diabetes as well as some of the special aspects associated with it.

- by Tomoyuki Kawamura
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- Child, Insulin, Diabetes mellitus, Glycemic Index
- by Robert Josse
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- Obesity, Diabetes, Apolipoproteins, Blood Glucose

Medical nutrition therapy plays a major role in diabetes management. Macronutrient composition has been debated for a long time. However, there is increasing evidence that a modest increase in dietary protein intake above the current recommendation is a valid option toward better diabetes control, weight reduction, and improvement in blood pressure, lipid profile, and markers of inflammation. Increasing the absolute protein intake to 1.5-2 g/kg (or 20-30% of total caloric intake) during weight reduction has been suggested for overweight and obese patients with type 2 diabetes and normal kidney function. Increased protein intake does not increase plasma glucose, but increases the insulin response and results in a significant reduction in hemoglobin A(1c). In addition, a higher dietary protein intake reduces hunger, improves satiety, increases thermogenesis, and limits lean muscle mass loss during weight reduction using a reduced calorie diet and increased physical activity. It is pre...

- by Osama Hamdy
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- Kidney diseases, Chronic kidney disease, Physical Activity, Diabetes mellitus

Self-care in diabetes: model of factors affecting self-care Aims and objectives. The aim of this paper is to explore self-care in diabetes and to present a model of factors that affect self-care according to reviewed literature. Background. Self-care in diabetes is crucial to keep the disease under control. Selfcare consists at least four aspects: (i) self-monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self-care such as knowledge, physical skills and emotional aspects and self-efficacy which have been listed as being of high importance. Methods. The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were 'self-care' or 'self-management' coexisting with diabetes and 'self-efficacy'. The search was limited to English and adults with type 1 diabetes. Results. The main components of the model clarify how knowledge, physical skills and emotional factors as well as self-efficacy influence self-care which again affects metabolic control. Flexible self-care indicates high level of self-care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self-efficacy is a strong predictor of flexible self-care and affects metabolic control through increased perceived ability to conduct self-care. Conclusions. The review illuminated that benefits of self-care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self-care. However, factors affecting flexible self-care still require better identification. Relevance to clinical practice. The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes-related knowledge, physical skills and emotional factors in combination with self-efficacy and the four self-care areas. The effects of self-monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self-care.

- by Arún Sigurdardóttir
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- Psychology, Nursing, Self Care, Medicine
- by Duane Davis
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- Nursing, Counseling, Curriculum, Blood Glucose

Diet influences cardiovascular health through a number of mechanisms. Nutrition recommendations are of major importance both in primary and secondary prevention of cardiovascular disease (CVD). A great body of research has examined the role of specific nutrients, including fat, carbohydrates, fiber, and alcohol, in reducing CVD risk. More recently the focus has shifted to the effect of food groups, such as fruits and vegetables, whole grains, and nuts and dairy products, and favorable dietary patterns that combine a variety of nutrients. In this perspective, a “prudent” dietary pattern, characterized by high intakes of fruits, vegetables, legumes, fish, poultry and wholegrain cereals, has been associated with significantly lower risks for CVD factors. Mediterranean dietary patterns, as well as the DASH (Dietary Approaches to Stop Hypertension) pattern, have been proven to exert significant cardioprotective effects in secondary prevention of CVD. Achieving and maintaining a healthy body weight change (as an initial goal to reduce body weight by ~10% from baseline), an active lifestyle (a minimum of 30 min of physical activity for most days of the week), and a balanced diet constitute the goals of the intensive counseling recommended for individuals with CVD. Effective interventions should combine nutrition education with behavior-oriented counseling to help patients acquire the skills, motivation, and support needed to alter their lifestyle patterns.

- by Meropi Kontogianni
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- Nutrition, Obesity, Life Style, Physical Activity

B ecause the vast majority of the day-today care inherent in diabetes is handled by patients and their families (1,2), there is an important need for reliable and valid measures of diabetes self-management (3-6). Such measures are useful both for clinicians and educators treating individual patients and for researchers evaluating new approaches to care. Self-report is by far the most practical and cost-effective approach to self-care assessment, and yet is often seen as undependable. This article summarizes data drawn from 7 different studies on the norms, reliability, validity, and sensitivity to change of the Summary of Diabetes Self-Care Activities (SDSCA) measure, a brief self-report instrument for measuring levels of self-management across different components of the diabetes regimen (7). Generalizing from past research on diabetes self-management is made difficult by the heterogeneity of self-care measures used. The least defensible of these is the practice of using measures of diabetes control, such as glycated hemoglobin or physicians' judgments, as indicators of patients' self-care behaviors (5,8-10). Direct methods, including observation of skills such as glucose testing and monitoring (e.g., by pill counts and activity monitors), are labor-intensive and subject to reactivity (10). Patients' selfreports are also open to bias but can be made more reliable (11); for example, by asking specific, nonjudgmental questions in interviews (12) or questionnaires (13). Moreover, the extent to which participants' self-reports of self-care are vulnerable to biases such as social desirability can be assessed with measures that tap constructs, such as the tendency to give self-reports that are self-deceptive (highly desirable but honestly held), and impression management (the conscious tendency to give highly desirable self-reports) (14,15). Diabetes self-care includes a range of activities (e.g., self-monitoring of blood glucose, eating a low-saturated-fat diet, and checking one' s feet) and it is now well established that these different components do not correlate highly (16-18). Because selfcare is multidimensional, it is necessary to assess each component separately rather than to combine scores across components (10). However, earlier self-report measures of diabetes self-care, such as the Diabetes Regimen Adherence Questionnaire (19) and the self-report measure of compliance developed by Cerkoney and Hart (20) and used in several subsequent studies (13,21, 22), combined responses across the different regimen areas to produce a total adherence or compliance score. In contrast, the self-report measure developed by Orme and Binik (18), adapted from the Rand Corporation diabetic adherence questionnaire (23), assessed the frequency with which behaviors were performed for 5 separate self-care areas. Similarly, Johnson et al. (24) developed a 24-h recall interview to address 13 aspects of the diabetes regimen that form 4 independent factors: exercise, injection, diet type, and eating/testing frequency (25). The original SDSCA measure (7) assessed 5 aspects of the diabetes regimen: From the Chronic Illness Research Group (D.J.T.

- by Deborah Toobert
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- Self Care, Smoking, Questionnaire, Reliability

Medical nutrition therapy is the first line of treatment for the prevention and management of type 2 diabetes and plays an essential part in the management of type 1 diabetes. Although traditionally advice was focused on carbohydrate quantification, it is now clear that both the amount and type of carbohydrate are important in predicting an individual’s glycemic response to a meal. Diets based on carbohydrate foods that are more slowly digested, absorbed, and metabolized (i.e., low glycemic index [GI] diets) have been associated with a reduced risk of type 2 diabetes and cardiovascular disease, whereas intervention studies have shown improvements in insulin sensitivity and glycated hemoglobin concentrations in people with diabetes following a low GI diet. Research also suggests that low GI diets may assist with weight management through effects on satiety and fuel partitioning. These findings, together with the fact that there are no demonstrated negative effects of a low GI diet, suggest that the GI should be an important consideration in the dietary management and prevention of diabetes.

- by Jennie Brand-miller
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- Cardiovascular disease, Blood Pressure, Weight Loss, Glycemic Index

Abstract: Type 2 diabetes mellitus (T2DM) has dramatically increased throughout the world in many ethnic groups and among people with diverse social and economic backgrounds. This increase has also affected the young such that over the past decade, the increase in the number of children and youth with T2DM has been labeled an ‘epidemic’. Before the 1990s, it was rare for most pediatric centers to have significant numbers of patients with T2DM. However, by 1994, T2DM patients represented up to 16% of new cases of diabetes in children in urban areas and by 1999, depending on geographic location, the range of percentage of new cases because of T2DM was 8–45% and disproportionately represented among minority populations. Although the diagnosis was initially regarded with skepticism, T2DM is now a serious diagnostic consideration in all young people who present with signs and symptoms of diabetes in the USA.

- by orit hamiel
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- Obesity, Treatment, Adolescent, Child

Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes.

- by Gabrielle Turner-McGrievy
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- Nutrition, Treatment Outcome, Lipids, Blood Glucose

Hypertrichosis in a newborn girl infant of a diabetic mother with congenital hypothyroidism is reported. Both neonatal hyperinsulism and increased testosterone levels were documented. The hypertrichosis resolved after 3 months' of thyroxine replacement treatment. The possible causal association between hypothyroidism, and hypertrichosis has not been previously reported in neonatal period. Thyroid function should be evaluated in all newborn babies with hypertrichosis or abnormal distribution of body hair.

- by Mustafa Akcakus
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- Turkey, Gestational diabetes, Pregnancy, Thyroxine
- by Elizabeth Chacko
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- Sociology, Anthropology, Ayurvedic Medicine, Culture

Objective: To clarify adherence of type II diabetic patients to dietary recommendations. Subjects and methods: The dietary habits of a group of 540 patients, with type II diabetes (male 322/female 218, mean age 6175 years, body mass index (BMI) 29.775.2 kg/m 2 ; mean7s.d.) referring to six Italian diabetes centres were evaluated by means of a 3-day diet record (2 workdays, 1 holiday). Diet records were analysed according to Italian food composition tables and compared with the dietary recommendations of the Diabetes and Nutrition Study Group of the European Association for the study of Diabetes. Results: Calorie intake was 17257497 kcal (1800 for men, 1610 for women). Mean intake for each nutrient was close to the recommended amount, except for fibre (12/1000 vs 20 g/1000 kcal). Calculating the percentage of patients who complied with each recommendation, the intakes of saturated fat and fibre least reflected the dietary target: in 43% of patients saturated fat was 410% of total calories, in only 6% was fibre intake X20 g/1000 kcal (considered ideal), and in 25% it was X15 g/1000 kcal (acceptable). Conclusions: These results indicate that compliance to dietary recommendations is not completely satisfactory, even in Italy. Calorie intake is a bit elevated, given the high BMI of our diabetic population. As to dietary composition, there are two crucial issues: the high intake of saturated fat and -most importantly -the low intake of fibre. All strategies aiming to a proper implementation of guidelines should take these results into due account.

- by Franco Cavalot
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- Nutrition and Dietetics, Italy, Patient Compliance, Body Mass Index
- by Meropi Kontogianni
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- Nutrition, Obesity, Life Style, Physical Activity

Aims and objectives. The aim of this paper is to explore self-care in diabetes and to present a model of factors that affect self-care according to reviewed literature.Background. Self-care in diabetes is crucial to keep the disease under control. Self-care consists at least four aspects: (i) self-monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self-care such as knowledge, physical skills and emotional aspects and self-efficacy which have been listed as being of high importance.Methods. The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were ‘self-care’ or ‘self-management’ coexisting with diabetes and ‘self-efficacy’. The search was limited to English and adults with type 1 diabetes.Results. The main components of the model clarify how knowledge, physical skills and emotional factors as well as self-efficacy influence self-care which again affects metabolic control. Flexible self-care indicates high level of self-care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self-efficacy is a strong predictor of flexible self-care and affects metabolic control through increased perceived ability to conduct self-care.Conclusions. The review illuminated that benefits of self-care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self-care. However, factors affecting flexible self-care still require better identification.Relevance to clinical practice. The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes-related knowledge, physical skills and emotional factors in combination with self-efficacy and the four self-care areas. The effects of self-monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self-care.

- by arun arun
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- Psychology, Nursing, Self Care, Insulin

Although insulin is life sustaining for patients with insulin-dependent diabetes mellitus (IDDM), the meal plan is of critical importance for avoiding hyperglycemia, preventing hypoglycemia, and maintaining metabolic balance. Consistency, timing, composition, and caloric content of food intake and physical activity, age, sex, growth, and pubertal status alter meal-plan needs. Self-monitoring of blood glucose should be used to individualize the meal plan. The general American Diabetes Association recommendations suggest that 50-65% of total calories be from carbohydrates from foods with a lower glycemic index and/or high fiber content. Protein should contribute 12-20% of total calories and fat <30%, with <10% saturated fat and <300 mg/day cholesterol. More severe fat restriction should be considered in individuals with persistent lipid abnormalities when compared with sex-and ageadjusted values. Calories should be sufficient for growth and development, with growth data obtained several times a year and plotted on standardized weight, height, and velocity charts. Blood pressure should be similarly plotted on age-and sex-standardized curves. All meal plans should be individualized, but certain circumstances require special attention in IDDM patients: 1) lack of minerals or vitamins in a youngster who is a picky eater; 2) eating disorders (i.e., obesity, bulimia, anorexia nervosa); 3) specific gastrointestinal diseases (i.e., Crohn's disease, celiac disease, giardiasis, or IgA deficiency); 4) low iron stores because of associated achlorhydria and positive gastroparietal antibodies; 5) alternative sweeteners, especially in pregnant women and very young children; 6) mineral balance changes that may occur with increased soluble fiber intake and episodes of hyperglycemia with or without ketosis/ketoacidosis; 7) changes in physical

- by Stuart J Brink
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- Adolescent, Child, Young Adult, Patient Compliance

Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes. Diabetes self-management education (DSME) is an essential component of effective self-care. Yet, little research has compared the effect of mindful eating to DSME-based treatment. This study compared the impact of these two interventions in adults with type 2 diabetes mellitus. A prospective randomized controlled trial with two parallel interventions was used. Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more, body mass index (BMI) of 27 or more, and hemoglobin A1c (HbA1c) of 7% or more who were randomly assigned to a 3-month mindful eating (MB-EAT-D; n=27) or Smart Choices (SC) DSME-based (n=25) intervention. Follow-up occurred 3 months after intervention completion. Dietary intake, physical activity, weight, HbA1c and fasting plasma glucose, and fasting insulin were assessed using repeated measures analysis of var...

- by Jean Kristeller
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- Obesity, Self Care, Blood Glucose, Insulin

OBJECTIVE -To investigate the characteristics of a food frequency questionnaire (FFQ) in measuring dietary intake in an adult insulin-dependent diabetes mellitus (IDDM) population. FFQs have been widely used in developed countries to assess usual dietary intake; however, information regarding the application of the method to individuals advised to follow a specific dietary regimen (such as people with IDDM) is scarce.

- by Malcolm Riley
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- Nonparametric Statistics, Adolescent, Confidence intervals, Tasmania

Background: Findings from the literature and clinical practice describe the various strategies necessary on a regular basis to control blood sugar levels in people with diabetes and suggests that guided imagery techniques aid clients in adhering to the rigorous diabetic routine. Methods and Results: An imagery script was developed and used to aid diabetic clients in maintaining their diabetic regimen. Participants in this cognitive experience indicated that the motivation script used with them by health-care practitioners was effective. The major treatment areas were blood testing, regular exercise, weight management, and consumption of a restricted lifetime diet. Several of these areas showed modification after the use of guided imagery.

- by Sylvia Kubsch
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- Self Care, Holistic Nursing, Motivation, Patient Compliance
- by Giuseppe Seghieri
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- Insulin, Diabetic Retinopathy, Clinical Sciences, Type 2 Diabetes Mellitus
- by George Bakris
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- Life Style, Hypertension, Blood Pressure, Diuretics

The recommendations in this paper are based on the evidence reviewed in the following publication: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications (Technical Review). Diabetes Care 25:148-198, 2002. The initial draft of this paper was prepared by a work group consisting of Marion J. Franz, MS, RD, CDE (co-chair), John P. Bantle, MD (co-chair);

- by Byron Hoogwerf
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- Medicine, Energy Metabolism, Pregnancy, Diabetes mellitus

Background: The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). Methods: 35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences.

- by Enza Gucciardi
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- Focus Groups, Self Care, Social Support, Qualitative Research

It is accepted worldwide that an effective multidisciplinary management team is essential for providing comprehensive self-management training to type I diabetics and their families. Therefore, the authors developed an intensive multidisciplinary education team that included pediatric endocrinologists, a dietitian, a psychologist, nurses, scientists and volunteers in the Department of Pediatrics, Siriraj Hospital in August 1996. This study aimed to analyze twenty-four newly diagnosed diabetics who underwent this specified program and multidisciplinary team approach in comparison to twenty-eight diabetic patients who were diagnosed before the program and team were established in order to see whether the length of hospitalization had been reduced and to compare the readmission rates of recurrent DKA with previous patients. The results demonstrated that by using the intensive program and multidisciplinary team the average length of admission was reduced from 36.04 days to 17.63 days (p...

- by Supawadee Likitmaskul
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- Program Evaluation, Thailand, Health Services Research, Adolescent

A primary care group diabetes care program using telemedicine was developed and its feasibility and acceptability were tested in 22 subjects with Type 2 diabetes mellitus using a one-group, pretestposttest quasi-experimental design. Compliance with the program was 100%. Significant reductions in total calorie intake as well as body mass index were achieved, with an increase in the percentage of subjects achieving better diabetes control as measured by the 2-hr hemastix. Improvements in diabetes knowledge and disease-specific and generic measures of quality of life were also observed. Most subjects evaluated this mode of service delivery favorably in the questionnaire and focus group discussions. There is potential for the integration of this mode of service delivery into current health services. D

- by Jerry Lai
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- Program Evaluation, Nursing, Primary Care, Primary Health Care

Objective: This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM). Methods: Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin Ͼ7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA. Results: The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m 2 (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20 -35% from fat (Ͻ7% saturated), and 20% from protein.

- by Barbara Olendzki
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- Nutrition, Life Sciences, Physical Activity, Treatment Outcome
- by Leonardo Orozco
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- Diet, Exercise, Reviews, Type 2 Diabetes Mellitus

Type 2 diabetes Glycemic control Low-carbohydrate diet Mediterranean diet Low-fat diet Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes (T2DM) and the debate persists: which dietary... more

- by Sivan Ben-Avraham
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- Obesity, Calorie restriction, Weight Loss, Glycemic Index
- by John Morley
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- Blood Glucose, Nursing Homes, Patient Compliance, Patient Satisfaction

- by Ilana Harman-Boehm
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- Obesity, Calorie restriction, Weight Loss, Glycemic Index

An important objective of diabetes care bs to provide patients with selfregulation skills. For patients to assume responsibility for their own regimens, they need to have good problem-solving skills to cope with ongoing personal, social, and environmental barriers to adherence. Therefore, a Diabetes Problem Solving Interview for adults was developed and evaluated with 126 non-insulin-dependent outpatients. Interviewers elicited problemsolving strategies patients would use to cope with a variety of situations potentially interfering with dietary, exercise, and glucose testing adherence. Interviews were tape recorded and coded by trained raters to produce scores on both overall problem-solving skill ratings and frequency of use of different types of strategies. Results revealed only minor influences of patient characteristics on problem-solving measures. Prospective analyses revealed that problem-solving measures were significant and independent predictors of levels of dietary and exercise self-care at a 6-month follow-up.

This paper analyses the production and reception roles of 7- to 9-year-old children and 13- to 15-year-old adolescents in two-party, three-party and multi-party encounters in the dietary counseling of diabetics. In the two-party encounters, the adolescents had an active patient role, even though their engagement withered if they had to go through a long examination or if they were asked about a 'delicate issue'. In the three-party encounters, despite their good interactional competence, they often turned into withdrawn bystanders when the parent spoke on their behalf, complemented or corrected their talk. The 7- to 9-year-old children were mostly silent and the mother spoke for them. However, they were ready to answer the questions that were clearly addressed to them. Furthermore, they had their own interaction patterns. Firstly, even when absorbed in their play, they sharply intervened in the adults' talk in order to correct an inaccurate detail. Secondly, they particip...

- by Eeva Pyörälä
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- Communication, Group Processes, Adolescent, Counseling

Aim: To identify the effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) in single administration on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects. Methods: A randomized, single-blind, cross-over, clinical trial was carried out in 14 young, healthy, non-obese, volunteers. A basal metabolic profile, which included glucose level, insulin, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, creatinine, and uric acid, was measured. Subjects received a single administration of 300 kcal, gauged with water at 350 ml, of each of the following (at least 3 days apart): glucose 75 g, polymeric supplement (Ensure high calcium) 315 ml or Glucerna SR 323 ml. At the beginning of each administration and 30, 60, 90 and 120 min later, glucose and insulin concentrations were measured. Areas under the curve of glucose and insulin were calculated. First-phase and total insulin secretions and insulin sensitivity were also estimated. Results: Glucose level at 120 min was significantly lower after receiving Ensure high calcium or Glucerna SR. Administration of Glucerna SR resulted in a significant reduction in the areas under the curve of glucose and insulin, as well as in total insulin secretion with a tendency to be lower in their first phase. Insulin sensitivity was increased. Conclusions: A single administration of Glucerna SR to healthy subjects decreased the postprandial glucose and insulin states, as well as the insulin secretion; insulin sensitivity increased.

- by Eduardo Hernandez-Salazar
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- Adolescent, Blood Glucose, Insulin, Insulin Secretion

Medical nutrition therapy is the first line of treatment for the prevention and management of type 2 diabetes and plays an essential part in the management of type 1 diabetes. Although traditionally advice was focused on carbohydrate quantification, it is now clear that both the amount and type of carbohydrate are important in predicting an individual's glycemic response to a meal. Diets based on carbohydrate foods that are more slowly digested, absorbed, and metabolized (i.e., low glycemic index [GI] diets) have been associated with a reduced risk of type 2 diabetes and cardiovascular disease, whereas intervention studies have shown improvements in insulin sensitivity and glycated hemoglobin concentrations in people with diabetes following a low GI diet. Research also suggests that low GI diets may assist with weight management through effects on satiety and fuel partitioning. These findings, together with the fact that there are no demonstrated negative effects of a low GI diet, suggest that the GI should be an important consideration in the dietary management and prevention of diabetes.

- by Kate Marsh
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- Type 2 Diabetes, Cardiovascular disease, Blood Pressure, Weight Loss
- by Chittaranjan Yajnik
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- Obesity, Pancreatitis, Adolescent, Child

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/ patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carb-ohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.

- by Naomi Wedel and +2
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- Nutrition, Evidence Based Medicine, Physical Activity, Treatment Outcome

Aims: The aim of this study is to compare the efficacy of low glycaemic index (GI) vs. conventional carbohydrate exchange (CCE) dietary advice on glycaemic control and metabolic parameters in patients with type 2 diabetes.Methods: A total of 104 patients with type 2 diabetes were randomly assigned to either a low GI (GI) or CCE dietary advice over a 12-week period. The primary end-point was glycaemic control as assessed by glycated haemoglobin A1c (HbA1c), fructosamine level and plasma glucose. The secondary end-points were anthropometric measurements and metabolic parameters that include blood pressure, lipid profile and insulin levels. The oral antidiabetic medications remained unchanged throughout the duration of the study.Results: A low-GI diet was associated with significant changes in the fructosamine level (ΔGI = −0.20 ± 0.03; ΔCCE = −0.08 ± 0.03 mmol/l, p < 0.01) and waist circumference (ΔGI group = −1.88 ± 0.30 cm; ΔCCE group: −0.36 ± 0.4 cm, p < 0.05) at week 4. At week 12, the changes in fasting glucose (ΔGI = −0.03 ± 0.3; ΔCCE = 0.7 ± 0.3 mmol/l; p < 0.05) and waist circumference (ΔGI = −2.35 ± 0.47 cm; ΔCCE group = −0.66 ± 0.46 cm; p < 0.05) in the GI group was significantly lower than the CCE group. With the low-GI diet, the changes in postprandial glycaemia at time 0, 60, 150 and 180 min after consuming the standard test meal was lower than with the CCE diet (p < 0.05). No significant differences were found between the groups for the remaining parameters that were measured.Conclusions: Use of a low-GI diet resulted in significant changes of serum fructosamine level, plasma glucose and waist circumference in Asian patients with type 2 diabetes over a 12-week period compared with those following a CCE diet. The effect on HbA1c and other metabolic parameters was not significantly different between the two study groups but the improvement within the GI group was more pronounced and of clinical benefit.

- by chinna a.m
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- Anthropometry, Blood Glucose, Follow-up studies, Glycemic Index

Youth with type 1 diabetes do not count carbohydrates accurately, yet it is an important strategy in blood glucose control. The study objective was to determine whether a nutrition education intervention would improve carbohydrate counting accuracy and glycemic control. We conducted a randomized, controlled nutrition intervention trial that was recruited from February 2009 to February 2010. Youth (12 to 18 years of age, n = 101) with type 1 diabetes were screened to identify those with poor carbohydrate counting accuracy, using a previously developed carbohydrate counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n = 66, age = 15 ± 3 years, 41 male, diabetes duration = 6 ± 4 years, hemoglobin A1c [HbA1c] = 8.3% ± 1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90-minute class with a registered dietitian/certified diabetes educator...

- by Franziska Bishop and +1
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- Nonparametric Statistics, Treatment Outcome, Adolescent, Food Analysis