Implementation of the 1994 ADA Nutrition Recommendations for inpatients with niddm. Implementation of the 1994 ADA Nutrition Recommendations for Inpatients With NIDDM

Abstract

LEARNING OUTCOME: To determine the appropriateness of a flexible meal plan, versus a standard calorie-control meal plan, for patients with NIDDM in an acute care setting. Medical nutrition therapy has moved toward a more flexible and individualized treatment for self-management of diabetes. The calorie-controlled diet has been the standard treatment for patients with diabetes who are acutely ill, A potential disadvantage of the calorie-controlled diet is that it deprives patients of their food preferences at a time when they are acutely ill, have poor appetites and are possibly nutritionally compromised. The purpose of this study was to determine the appropriateness of a flexible meal plan, designed around the new nutrition guidelines, for patients with NIDDM in an acute care setting. Differences in blood glucose control, food choices, calorie and macronutrient intakes, and patient satisfaction between hospitalized adult inpatients on the traditional meal plan (n=20) and those on the new meal plan (n=15) were examined. Both groups were provided with selective menus appropriatate for patients with diabetes. The control group (CCM) received the 1986 American Diabetes Association (ADA) exchange-type diet, with calories and macronutrients controlled. The treatment group (GM) received food choices as selected using USDA Dietary Guidelines provided on the menu. Dietary intakes at meals and snacks were observed and recorded. Blood glucose was measured four times daily for three days. Insulin adjustments and other medications were recorded. A patient satisfaction survey was completed. No significant differences were seen between dietary intakes or meal satisfaction. Patients in the GM group received their food as ordered, and most patients in the CCM group required modifications. The new meal plan approach was not associated with deterioration of glycemic control. A decrease in fasting blood glucose values occurred on day 2 in the GM group versus the CCM group (152 mg/dL + 17 vs 203 mg/dL+14). The GM group received significantly more regular insulin on day 3 and their total insulin amount received, decreased. This study indicates that the more flexible, individualized and self-managed meal planning approach is as effective for patients with NIDDM in an acute care setting as the traditional approach. This new meal plan approach places the locus of control with the patient, allows diabetes educators to apply a problem-solving approach using the general ADA menu as an assessment tool, and is based on flexible food choices resulting in improved diabetes self-management.