Diabetes Medical Nutrition Therapy Research Articles

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention.

Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Chinese clinical trial registry, ChiCTR2200060923.

SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women

BackgroundAfrican American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. MethodsA randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DiscussionThe results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.

Nutrition-Education-Based Interventions in Gestational Diabetes: A Scoping Review of Clinical Trials.

Cases of diabetes mellitus have seen a global increase in prevalence, but there are inherent differences in the pathology and management of different types of diabetes. Type 2 and gestational diabetes have the most similar pathophysiology. For that reason, many similar management strategies exist between type 2 and gestational diabetes, including nutrition-based interventions. Diabetes self-management education and medical nutrition therapy have been advanced as cost-effective interventions to manage hyperglycemia. Many of these interventions, however, were designed for type 2 diabetes and adapted for diabetes in gestation. Nutrition-education-based interventions in gestational diabetes have not been fully elucidated. We scrutinized this gap by conducting a scoping review of recently published peer-reviewed studies that evaluated clinical endpoints in cases of gestational diabetes with nutrition-education-based interventions. The search yielded 621 articles, and the 12 articles included were published between 2012 and 2022. The nutrition information varied across the heterogeneous diabetes self-management education, whereas the medical nutrition therapy studies were more consistent. Our literature search revealed similar outcomes across self-management education and medical nutrition therapy interventions implemented during the third trimester of pregnancies with diabetes. These results suggest that both generalized and personalized approaches to nutrition education in gestational diabetes can manage hyperglycemia and offset its adverse consequences.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus

ObjectiveTo identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. Material and methodsAnalytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the “Instrument for measuring lifestyle in patients with type 2 diabetes mellitus” (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. ResultsWomen comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = 0.003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < 0.05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < 0.05). ConclusionDiabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2

ObjectiveTo identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. MethodsAnalytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. ResultsWomen comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). ConclusionDiabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

280-OR: Medical Nutrition Therapy and Glycemic Control in Youth-Onset Diabetes: SEARCH for Diabetes in Youth Study

Medical nutrition therapy (MNT) is integral to diabetes (DM) management, but little is known about MNT use in youth and young adults. The SEARCH for Diabetes in Youth study assessed MNT use among 1476 participants with type 1 DM (T1D) and 245 with type 2 DM (T2D) who had up to 3 research visits over 5.2 years (range 1.7-11.5). Participants reported often, sometimes, or never using each of 10 MNT strategies, which we categorized with 5 mutually exclusive groups: often using across visits; start using at later visits; sometimes using across visits; stop using at later visits; or never using at every visit. We used general linear models to examine A1c levels at the most recent visit (mean 11.0 [range 6.3-17.0] years after DM diagnosis) for each MNT strategy, adjusting for sociodemographic and DM-related variables. Most participants with T1D reported often counting carbs (n=1080, 75%), while half (n=107, 47%) of those with T2D reported often limiting sweets. Table presents significant associations of A1c levels with MNT use by DM type. In T1D, mean A1c differed significantly across MNT use of 7 strategies, but only for 2 strategies in T2DM. For both T1D and T2D, A1c did not differ by use of dietary exchanges, drinking more milk, or eating more fruits/vegetables. Our data suggest that often using most MNT strategies is related to relatively better glycemic control in T1D, but this applies to fewer MNT strategies for T2DM. Disclosure K.A. Sauder: None. J.M. Stafford: None. N.S. The: None. E.J. Mayer-Davis: None. J. Thomas: None. J.M. Lawrence: None. G. Kim: None. K.R. Siegel: None. E.T. Jensen: None. A.S. Shah: None. R. Dagostino: Consultant; Self; Amgen, AstraZeneca, Celgene, Daiichi Sankyo. D. Dabelea: None. Funding National Institutes of Health

The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe

Introduction: Diabetes self-management education (DSME) and medical nutrition therapy (MNT), provided by diabetes educators and registered dietitians respectively, considerably improve glycaemic control. However, it is unknown what interventions exist in many African countries and the impact thereof. Aim: To determine the impact of existing DSME interventions on knowledge, attitudes and practices (KAP) of adults with type 2 diabetes attending public health care facilities in Harare, Zimbabwe. Methods: A cross-sectional, researcher-administered survey was designed to assess DSME KAP at eight outpatient diabetes clinics that provide diabetes services. Participants were conveniently sampled. Associations between mean scores for knowledge, attitudes and practices were compared between characteristics of DSME interventions. Results: A total of 154 participants were recruited and divided evenly between two tertiary (n = 77) and six primary outpatient clinics (n = 77). The mean age was 61.8 years (SD ± 12.7), mean years since diagnosis with diabetes was 8.1 years (SD ± 8.3) and the majority were females (66.9%, n = 103). Most participants (90.3%, n = 139) reported receiving some DSME. Participants most frequently cited a tertiary clinic as the place where DSME was received. Fewer had consulted a dietitian (49.0%, n = 76) or diabetes educator (52.0%, n = 80). Higher levels of diabetes knowledge were observed for tertiary clinic attendees (p = 0.00), consultation with a dietitian (p < 0.01) and diabetes educator (p = 0.00). Only those who had consulted a dietitian reported better adherence to dietary guidelines (p = 0.00) and physical activity (p = 0.02) self-care behaviours. Conclusion: Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur.

Quality and readability of online information about type 2 diabetes and nutrition.

The internet has become a vital resource through which patients learn about medical conditions. The aim of this study was to assess the quality and readability of online information about nutrition and diabetes management. An internet search was conducted using three search terms of varying sophistication (how to eat with diabetes, diabetes diet, and medical nutrition therapy for diabetes) and the three most popular search engines (Yahoo, Bing, and Google). Forty-two websites were prospectively analyzed for quality of information and assessed for readability using the Flesch-Kincaid score. The 42 websites reviewed demonstrated wide variability in quality, regardless of the search term entered. The reading level required to understand the materials varied based on sophistication of the search term and ranged from the 6th- to the 11th-grade level. The quality of online information on nutrition education for patients with diabetes was extremely variable and readability often was higher than the average American reading level (8th grade). An awareness of quality and readability of the materials found on the internet can strengthen the patient-provider relationship.

Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review

BackgroundDiabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease. ObjectiveDocument outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association–recognized programs. DesignDescriptive, retrospective chart review. Participants/settingFour random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained. Outcome measuresWeight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio. AnalysisMixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters. ResultsSignificant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001). ConclusionsReductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Identification of Generalist Registered Dietitian Nutritionist Knowledge Gaps in Diabetes Medical Nutrition Therapy Compared to Diabetes-Credentialed Registered Dietitian Nutritionists: Results of a Survey to Inform Educational Opportunities

Identification of Generalist Registered Dietitian Nutritionist Knowledge Gaps in Diabetes Medical Nutrition Therapy Compared to Diabetes-Credentialed Registered Dietitian Nutritionists: Results of a Survey to Inform Educational Opportunities

Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women

ObjectivesTo assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI) pilot study intervention and factors that influenced long-term dietary self-care.Research design and methodsPilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments.ResultsAmong the 12 participants (mean age 57.1±5.7 years), improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22), systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25), frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5), and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5). There was a statistically significant decrease (p=0.04) in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0). Dietary self-care barriers and facilitators included internal (eg, motivation) and external factors (eg, social support). Motivation (70 comments) and lack of motivation (67 comments) were the most pervasive facilitator and barrier subthemes, respectively.ConclusionOverall, diabetes-related clinical and dietary self-care outcomes were improved following a combined medical nutritional therapy/MI intervention, and motivation played an important role in dietary self-care engagement. Future research is needed to assess the added benefit of MI in improving clinical and dietary self-care outcomes and to identify best strategies to support post-intervention dietary self-care engagement.

Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions through Retrospective Chart Review

BackgroundDiabetes self-management education (DSME) and medical nutrition therapy (MNT) improve patient outcomes; poor reimbursement limits access to care. ObjectiveOur aim was to develop methodology for tracking patient outcomes subsequent to registered dietitian nutritionist interventions, document outcomes for patients with type 2 diabetes attending an American Diabetes Association-recognized program, and obtain outcome data to support reimbursement and public policy initiatives to improve patient access to DSME and MNT. DesignRetrospective chart review. Participants/settingA random sample of 100 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSME and individualized MNT, June 2013 to 2014. Outcome measuresData were extracted on body mass index (calculated as kg/m2), weight, hemoglobin A1c, blood glucose, and lipids. Statistical analysisMixed-model analysis of variance was used to determine differences between means for continuous variables; McNemar’s tests and γ-statistic trend analysis were used to assess frequency of patients reaching glycemic targets. ResultsSignificant weight loss was observed from baseline (94.3±21.1 kg) to end of program (91.7±21.2 kg [−1.6±3.9 kg]; P<0.001); weight loss in whites (−5.0±8.4 kg; P<0.001) exceeded that of African Americans (−0.8±9.0 kg; P>0.05). Significant hemoglobin A1c reduction was observed from baseline (8.74%±2.30%) to end of program (6.82%±1.37% [−1.92%±2.25%]; P<0.001) and retained at 1 year (6.90%±1.16%; P<0.001). Comparatively, 72% of patients reached hemoglobin A1c targets (≤7.0%) vs 27% at baseline (P=0.008). When stratified by diet alone and diet plus drug therapy, patients exhibited a 1.08%±1.20% (P<0.001) and 2.36%±2.53% (P<0.001) reduction in hemoglobin A1c, respectively. Triglycerides decreased from baseline 181.6±75.5 mg/dL (2.0±0.9 mmol/L) to 115.8±48.1 mg/dL (1.3±0.5mmol/L) (P=0.023). High-density lipoprotein increased from 41.4±12.4 mg/dL (1.1±0.3 mmol/L) to 47.3±12.4 mg/dL (1.2±0.3 mmol/L) (P=0.007). ConclusionsRetrospective chart review provides an operational model for abstracting existing patient outcome data subsequent to registered dietitian nutritionist interventions. In support of universal reimbursement and patient access to DSME with supplemental individualized MNT, reductions were observed in key outcome measures weight, body mass index, hemoglobin A1c, and triglycerides.

An appraisal of food serving characteristics among patients with type 2 diabetes mellitus attending a tertiary care diabetes facility in Sri Lanka

Introduction: The primary objective of the present study was to identify the portion sizes of food consumed by adult type 2 diabetic patients in Sri Lanka and to evaluate if these were within the current recommendations. Materials and Methods: A cross sectional survey was performed at a tertiary care diabetes facility in Sri Lanka. Starch, fruits, vegetables, meat or alternative, pulses, dairy and added sugar consumption was assessed according to standard methods using a 24-hour dietary recall. Results: One hundred and twenty three randomly selected adult type 2 diabetic patients were studied. Forty six percent of participants exceeded the national recommendation of 4.5 to 9 servings of starch per day for patients with diabetes. Mean daily consumption of starch was 10.5 (median 10.2 IQR 4.7) servings. Only 26% and 45% of participants consumed the recommended 2 servings of fruits and 3 servings of vegetables per day. Thirty three percent and 8% did not consume any fruits or vegetables respectively. Dairy products were consumed by 25% only. Added sugar was not used by 99% of participants. Portion size was smaller in females and with advancing age. The mean proportions of total Carbohydrates, proteins and fats comprising total energy intake were 68.1%, 11.5% and 20.2% respectively. Discussion: Medical nutrition therapy in diabetes recommends a mixed diet with carbohydrates from a variety of sources such as cereals, fruits and vegetables. Although Sri Lankan patients with diabetes consume less starch and more fruits and vegetables compared to non-diabetic counterparts, a substantial proportion still fail to meet the recommendations.

Dietary intake in Japanese patients with type 2 diabetes: Analysis from Japan Diabetes Complications Study.

Though there are many differences in dietary habits and in the metabolic basis between Western and Asian people, the actual dietary intake in Asian patients with diabetes has not been investigated in a nationwide setting, unlike in Western countries. We aimed to clarify dietary intake among Japanese individuals with type 2 diabetes, and identify differences in dietary intake between Japanese and Western diabetic patients. Nutritional and food intakes were surveyed and analyzed in 1,516 patients with type 2 diabetes aged 40-70years from outpatient clinics in 59 university and general hospitals using the food frequency questionnaire based on food groups (FFQg). Mean energy intake for all participants was 1737±412kcal/day, and mean proportions of total protein, fat, and carbohydrate comprising total energy intake were 15.7, 27.6 and 53.6%, respectively. They consumed a 'low-fat energy-restricted diet' compared with Western diabetic patients, and the proportion of fat consumption was within the suggested range that has been traditionally recommended in Western countries. As a protein source, consumption of fish (100g) and soybean products (71g) was larger than that of meat (50g) and eggs (29g). These results imply that dietary content and food patterns among Japanese patients with type 2 diabetes are quite close to those reported as suitable for prevention of obesity, type 2 diabetes, cardiovascular disease, and total mortality in Europe and America. A large difference was shown between dietary intake by Japanese and Western patients. These differences are important to establish ethnic-specific medical nutrition therapy for diabetes.

비만 및 비비만 인슐린 비의존형 당뇨병환자의 영양소 섭취량 비교 분석

This study compared the nutrient intake of obese versus non-obese non-insulin dependent diabetes mellitus (NIDDM) patients for Diabetes Medical Nutrition Therapy. The study was conducted at medical hospitals in Gyeonggi and Seoul from April 2009 to November 2009. Fifty-six adult male NIDDM patients were enrolled and divided into two groups: 36 into an obese group (BMI <TEX>${\geq}25$</TEX>) and 20 into a non-obese group (BMI<25). To conduct this study, anthropometric measurements, and daily nutrient intake of obese and non-obese NIDDM patients were measured. Daily nutrient intake was estimated by 24hr-recall and analyzed by the CAN program. In the results, anthropometric measurements of the two groups showed significant differences in weight and BMI (p<0.001). Daily nutrient intake of the two groups showed no significant differences, except for vitamin E intake (p<0.05). The total energy intake of the non-obese and obese groups were <TEX>$2,669.9{\pm}964$</TEX> kcal and <TEX>$2,555.4{\pm}803$</TEX> kcal, respectively, which were both above 113% of the recommended Dietary Reference Intakes for Korean (KDRIs). Cholesterol and sodium intake were <TEX>$378.1{\pm}215.6$</TEX> mg and <TEX>$6,478.9{\pm}2755.1$</TEX> mg, respectively for the non-obese group. Cholesterol and sodium intake were <TEX>$308.1{\pm}155.6$</TEX> mg and <TEX>$6,306.8{\pm}2788.9$</TEX> mg, respectively, for the obese group. Both groups were above 150% of the recommended levels set by the Korean Diabetes Association (KDA). However, their antioxidant nutrient intake was appropriate. Meanwhile, their fiber intake was <TEX>$10.7{\pm}5.1$</TEX> g and <TEX>$9.8{\pm}5.2$</TEX> g, respectively, which was lower than 40% of the recommended intake set by the KDA. The results show that the nutritional education for obese and non-obese NIDDM male patients must aim to reduce total energy, cholesterol, and sodium intake, while increasing fiber intake. In addition, the factors related to a patient's glycosylated hemoglobin, serum lipids, blood pressure, and weight change must be calibrated for the appropriate energy, fat, cholesterol, sodium, and dietary fiber intake.

Expert consensus on medical nutrition therapy for diabetes

Expert consensus on medical nutrition therapy for diabetes

Promoting Healthful Eating Patterns Among Patients With Diabetes

There is a quote attributed to Hippocrates that reads, “Let food be thy medicine, thy medicine shall be thy food.” It is easy to recognize the significance of this advice when working with patients with diabetes. Nutrition therapy has been recognized as a crucial component of diabetes management since the discovery of the disease. General goals of diabetes nutrition therapy are to achieve and sustain blood glucose and blood pressure as near to normal as possible, as well as a lipid profile that decreases the risk for cardiovascular disease; to prevent chronic complications; to address individual nutrition needs; and to maintain the pleasure of eating.1 Although it is recommended that a registered dietitian (RD) experienced in diabetes medical nutrition therapy (MNT) take the lead role in providing nutrition care for individuals with diabetes,1 all health care professionals who see patients with diabetes play a contributing role in promoting healthful eating. For busy clinicians, messages about healthful eating and physical activity often go unsaid because of the short duration of time actually spent face to face with patients. Health care professionals encountering patients with diabetes throughout their course of care can make a difference by reinforcing positive messages about healthful food choices and physical activity and sharing the belief that it is possible to make changes. These brief messages may be more important than clinicians realize. Controversy surrounded the recent revelation from celebrity chef Paula Deen that she had been diagnosed with type …

Reimbursement for Shared Medical Appointments Incorporating Diabetes Self-Management Education/Training or Diabetes Medical Nutrition Therapy

In Brief What patients with diabetes want and need for the successful management of their disease is exactly what shared medical appointments (SMAs) can provide. Topping the list are increased access to care, quality time with the physician, an active role in medical and lifestyle decision-making, their unique needs individually addressed in a timely manner, and encouragement and support from other people with diabetes. For health care professionals, SMAs are a cost-effective way to provide both diabetes medical management and self-care education in the same visit in a manner consistent with highly interactive patient-centered care. This article offers an overview of Medicare and private insurance reimbursement for SMAs.

Medical nutrition therapy for diabetes: The challenge in India

Medical nutrition therapy for diabetes: The challenge in India