Diabetes Management Goals Research Articles

Enhancing support via interactive technologies.

Despite some improvements in diabetes treatment processes, outcomes for many patients remain inadequate. Interactive health technologies (IHTs) can address many of the challenges that diabetes patients and their health systems face, and research on IHT applications for diabetes care are intensifying. This article describes recent evidence regarding the feasibility and impact of 1) clinic-based CD-ROM systems supporting behavior change; 2) automated telephone diabetes management allowing for ongoing monitoring and patient education between face-to-face clinical encounters; and 3) Web-based systems focusing on a range of diabetes management goals such as enhanced emotional support for patients and improved clinician adherence to treatment guidelines. Studies in each of these areas have been somewhat encouraging. However, intervention effects have been moderate, and researchers face significant challenges in designing and implementing definitive studies.

Weight Loss, Diets, and Supplements: Does Anything Work?

It is estimated that at least two-thirds of adults are currently trying to lose weight or prevent weight gain.1 While many are eating less fat to manage weight, few are using the recommended strategies of eating fewer calories and increasing physical activity.1 Many individuals trying to lose or maintain weight engage in new behaviors for short periods of time. However, they are typically not able to maintain these new behaviors. In one study, for example, individuals reported using each of the following behaviors at least once in 4 years, but used these behaviors only 20% of the time: decreased fat intake (78.7%), reduced calories (73.2%), and increased exercise (82.2%).2 Individuals attempting to lose weight may have unrealistic expectations, and if their expectations are not met, they may give up. Data suggest that people who want to lose weight want to lose, on average, at least 32% of their initial body weight3 even though health professionals recommend a weight loss of only 5–10% to improve obesity-related complications (e.g., lowering blood pressure or improving lipids).4 Weight-loss goals set by individuals are based more on appearance and physical comfort than on improved health.3 Because weight-loss expectations differ from traditional, recommended programs that encourage small weight losses over time, consumers are turning to other diet gimmicks in hopes of achieving their goals.5 Americans are spending $33 billion annually for weight-loss products and services6 for which there may or may not be evidence supporting their effectiveness. This article reviews popular weight-loss diets and supplements. It also discusses prioritization of weight-management goals with diabetes management goals and offers key counseling messages. ### Diets. The past 50 years have seen a proliferation of diets. These have ranged from total fasting, to consuming 300–400 calories/day of liquid supplements, to eating 1,200–2,100 calories/day …

PCV21 Cost Consequences of Acute Myocardial Infarction in Diabetic Patients-The First Year

In developing an economic model of type 2 diabetes mellitus, the costs associated with its complications were examined. This presentation focuses on the first year costs associated with acute myocardial infarction (MI). OBJECTIVE: To estimate the first year costs of initial acute care (accommodation, procedure and ancillary hospital charges and MD fees) and subsequent care (rehabilitation, nursing, home health care, physician visits, lab, medications, surgical and invasive cardiovascular procedures occurring post-discharge) accrued in the management of MI in diabetic patients. METHODS: Estimates for these costs were developed based on data from five all payer, acute care, state discharge databases (CA, FL, MA, MD, NC) and MA long term care data, using ICD9 codes to identify disease and procedure level data. These sources were supplemented by fee schedules, other agency and survey data and the literature. The proportions of patients consuming each type of subsequent resource use were estimated from discharge data for each population and published literature. All costs are reported in 1996 US$, adjusted appropriately for medical inflation and cost-to-charge ratios. RESULTS: Approximately 31,000 discharges of diabetic patients with a principal diagnosis of AMI were identified. The initial hospitalization was 7 days, on average, with a mean cost of $16,520. The case fatality rate in hospital was 11%, and 38% received some type of subsequent care post-discharge. Thus, hospitalization accounted for 60% of the total average first year costs ($27,630) accrued. CONCLUSION: Increased medical management resulting from an MI, which continues beyond the first year, adds a substantial cost burden. Avoidance of macrovascular complications should be a key goal of diabetes management.

Management of glycemia in type 2 diabetes

The management of type 2 diabetes has been revolutionized over the last 3 to 5 years as a result of dramatic changes in our health care system, new clinical trial data, novel pharmacologic agents, and a better understanding of appropriate methods for patient education regarding lifestyle issues. As a result, diabetes management has become much more heterogeneous, with dramatic differences in style and approach used by practitioners, whether diabetes specialists, primary care providers, or allied health professionals. Diabetes care has also become much more rewarding The vast majority of patients can now achieve excellent glycemic control while leading full and unrestricted lives. In this article, a construct is reviewed by which comprehensive diabetes care may be approached in a primary care setting. The overall goal of diabetes management should be to provide an opportunity for patients to live out their normal life expectancies with minimal complications. In other articles, screening and treatment suggestions for diabetes complications are provided. Prospective interventional and epidemiologic studies demonstrate that glycemic control is critical to avoidance of complications, the methods to achieve glycemic control are the major focus of this chapter.

Commentary and translation: 1994 nutrition recommendations for diabetes

Commentary and translation: 1994 nutrition recommendations for diabetes

Nutrition management for individuals with noninsulin-dependent diabetes mellitus in the 1990s: A review by the Diabetes Care and Education dietetic practice group

Noninsulin-dependent diabetes mellitus (NIDDM), or Type II diabetes, is characterized by two primary defects: insulin resistance and insulin secretion. The two major goals of management of NIDDM are to achieve near normal metabolic control and to prevent/delay the microvascular and macrovascular complications of diabetes. Nutrition, exercise, and, if necessary, medication are the three primary treatment modalities used in NIDDM. Treatment regimens need to be individualized and developed with consideration for diabetes management goals and quality-of-life issues. Lean individuals with NIDDM should be encouraged to maintain their body weight and modify food composition and eating pattern to minimize glucose excursions. The primary treatment goal for an obese individual with NIDDM is weight loss. The process of teaching nutrition and meal planning involves developing a cooperative alliance, gathering information, setting realistic goals, intervention, and maintaining change. Nutrition intervention involves providing information in stages, beginning with "survival skill" information and progressing to in-depth information. The dietitian's responsibility is to promote continuity of learning by introducing new ideas and concepts and altering the learning environment. Dietitians can expand their role in the 1990s to that of a diabetes educator taking a leadership role to ensure that the individual with NIDDM receives comprehensive and individualized care.

High-fiber diet for diabetes

Persons with diabetes are at increased risk for cardiovascular disease. Maintaining normal lipid levels is, therefore, a key goal in diabetes management. A high-carbohydrate, high-fiber diet provides effective, positive, and safe treatment for diabetes and lowers the associated risk for coronary artery disease.

Nutrition and diabetes: a review of current recommendations (continuing education credit).

Nutrition has long been described as the cornerstone of diabetes management. Important goals of nutrition therapy are to restore normal blood glucose and lipid levels, prevent complications, promote growth in children and weight maintenance in adults, and develop an individualized meal plan. Calorie content, and the distribution of carbohydrate, protein, and fat in the diet need to be individualized. Illness, exercise, and hypoglycemia may require special modification in food intake. Whenformulating a diet prescription, the dietitian needs to consider calorie needs, current eating habits, diabetes management goals, and medication schedule, as well as appropriate teaching materials for initial and in-depth continuing education.

Self blood glucose monitoring: An adjunct to dietary and insulin management of the patient with diabetes

The primary goal of diabetes management is to maintain blood glucose as near to normal as possible. Composition, size, and spacing of meals and snacks all have a substantial impact on blood glucose fluctuations and can be altered to improve glycemic control. Recent research studies focusing on the blood glucose response of various carbohydrate containing foods have found that responses vary considerably. Because the glucose response is influenced by numerous factors, it is difficult to predict how specific individuals will respond to a particular food. A technique known as self-blood glucose monitoring can be used by patients with diabetes to quantitate their own postprandial glucose rise from various foods. The technique itself is portable and relatively simple and is an accurate means of obtaining blood glucose values without using a clinical laboratory. Self-blood testing provides the patient with immediate feedback on the impact of dietary manipulation. Blood glucose records can be used in conjunction with diet records to make adjustments in the type and amount of food or insulin dose that would elicit the best glycemic response. The dietitian thus plays an integral role in identifying patterns in the blood glucose profile and assisting the patient in making intelligent dietary choices to improve diabetes control.