National Diabetes Education Program Research Articles

Managing Diabetes Effectively in the School Setting

For the nation’s 215,000 children and adolescents with diabetes, major advances in diabetes management, medical research, and technology mean a brighter future. At the same time, young people with diabetes face unique and sometimes dangerous immediate challenges due to sometimes unpredictable glucose levels. As the number of students with diabetes increases, and diabetes care technologies change and require more intense diabetes management in school and at home, school nurses face new and ongoing challenges in providing care to students with diabetes. The updated 2010 edition of Helping the Student With Diabetes Succeed: A Guide for School Personnel, published by the National Diabetes Education Program (NDEP), is now available. The purpose of the guide is to educate school personnel about effective diabetes management. The guide also shares a framework and a set of practices, based on the school health team approach, that enable schools to ensure a safe learning environment for students with diabetes, particularly those who use insulin to control the disease (all students with type 1 and most with type 2 diabetes). In this article, we provide sample case studies and answers to frequently asked questions to help school nurses put the NDEP school guide information into practice in the school setting.

Experiences of Children and Adolescents With Type 1 Diabetes in School: Survey of Children, Parents, and Schools

More than 160,000 children and adolescents with type 1 diabetes are enrolled in public and private schools in the United States.1,2 School children with type 1 diabetes must be afforded the proper time and tools for diabetes self-care to be safe, learn effectively, and be able to participate in all school activities.3,4 In addition, knowledgeable school personnel are needed to assist them when they do need help. Thanks to the efforts of the American Diabetes Association (ADA), the Juvenile Diabetes Research Foundation (JDRF), the National Diabetes Education Program (NDEP), and the Children with Diabetes Web site, much progress has been made in the past 20 years to ensure that children in schools are safe and protected. Each of these organizations has provided valuable educational and advocacy resources for parents and educational materials for school systems. The daily self-management of children and adolescents with type 1 diabetes is complex and dynamic. It requires frequent self-monitoring of blood glucose (SMBG), insulin injections, and individual meal plans.5-7 However, changes in daily schedules (e.g., recess, physical education class, school outings, and participation in sports) or an acute illness complicate children's blood glucose management while at school. In addition, children are continually growing during each academic year, requiring frequent changes to their individualized treatment plans. Decisions concerning adjustments in insulin doses occur often while children are in school and frequently must be made by a school nurse, parent, or guardian following protocols in the comprehensive diabetes care plan prescribed by the children's physicians.8,9 School nurses are the principal contact person between parents and guardians and health care providers with regard to updating children's individualized diabetes care plans for management of acute problems during the school day. Unfortunately, some school systems do not have …

Meal Planning Tips for Children and Adolescents With Diabetes

Many children are now using multiple daily insulin injections or insulin pump therapy that can readily accommodate unplanned eating situations or school parties. However, this does not mean that the child can eat whatever he or she wants as long it is “covered” with rapid-acting insulin because excessive weight gain may result. The child’s diabetes management plan should note how many carbohydrate (CHO) choices or grams of CHO are prescribed for lunch and a snack (National Diabetes Education Program, 2003). A shot or bolus of rapid-acting insulin given when the child eats mimics the way a normally functioning pancreas secretes insulin. The child’s plan also should state how much insulin the child needs to take for a specified number of grams of CHO. This formula is called an insulin-to-carbohydrate ratio. It is used in conjunction with the child’s blood glucose correction factor or sensitivity factor to correct an elevated premeal blood glucose level. At times, this insulin dose may be decreased for planned exercise. Also, depending on the child’s individual diabetes management plan (or self-management ability), he or she may be able to independently determine the quantity of CHO to consume for meals and snacks. Insulin needs change as the child grows. It is not uncommon for a child to have meal and insulin plans adjusted several times a year (American Diabetes Association [ADA], 2008). Note that it is very important for children who use a fixed-dose insulin injection plan, such as two injections a day, to eat planned meals and snacks on a schedule. A fixed-dose insulin plan uses a type of insulin that peaks around lunchtime. If the midday meal is delayed or skipped, there is an increased risk of hypoglycemia. Children using this type of insulin plan may also need a midmorning snack. Table 1 shows general amounts of carbohydrate recommended for lunch and snacks for children based on age. Tips for School Parties

Community Resources for Promoting Youth Nutrition and Physical Activity

Childhood obesity is a national public health crisis. The National Diabetes Education Program (NDEP), the National Institutes of Health and Kaiser Permanente have developed community tools and resources for children and families to lower their risk for obesity through healthier, active lifestyles. The authors describe innovative practices and community mobilization case studies from the NDEP “Move It! and Reduce Your Risk for Diabetes” program and the NIH We Can!TM - Ways to Enhance Children’s Activity and Nutrition, and programs from Kaiser Permanente for the promotion of healthier lifestyles for children and families. Replication of these creative programs can be modified to be implemented in communities throughout the United States.

Predictors of Perceived Risk of the Development of Diabetes

Abstract Objective. To describe predictors of perceived risk for the development of diabetes. Research design and methods. In 2006, the National Diabetes Education Program conducted a telephone survey of the U.S. population ≥ 45 years of age. The sample size for this study was 1,389 people who reported no previous diagnosis of diabetes. Logistic regression analyses were conducted to identify independent variables associated with the perception of risk for diabetes among people without a diagnosis of diabetes. Results. More than half (55%) of the U.S. population aged ≥ 45 years had one or more risk factors for diabetes, yet only about one-fourth (23%) felt they were at risk for the disease. In the multivariate analyses, feeling at risk for diabetes is associated with a younger age (45-64 vs. ≥ 65 years; odds ratio[OR] 2.50; 95% CI 1.56-4.01); being of a race or ethnicity other than white, African American, or Hispanic/Latino compared to non-Hispanic whites (OR 2.26; 95% CI 1.19-4.31); being obese (OR 3.23; 95% CI 1.90-5.50); having a family history of diabetes (OR 5.53; 95% CI 3.55-8.60); and having had a diagnosis of pre-diabetes (OR 5.80; 95% CI 3.31-10.16). African Americans are significantly less likely to feel at risk for diabetes compared to non-Hispanic whites (OR 0.53; 95% CI 0.29-0.96). Conclusions. Based on these findings, special attention needs to be placed on reaching older adults and African Americans who report significantly lower levels of self-perceived risk of diabetes. An emphasis on increased susceptibility due to a family history of diabetes, obesity, and a diagnosis of pre-diabetes appear to be meaningful cues to increasing perceived risk.

The National Diabetes Education Program's “Control Your Diabetes. For Life.” Campaign: Design, Implementation, and Lessons Learned

The National Diabetes Education Program (NDEP) is a federally sponsored national partnership including government, nonprofit, professional, and private sector organizations. The NDEP uses social marketing principles and processes to develop and implement awareness campaigns and educational activities to improve the treatment and health status of people with diabetes. Co-sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), NDEP launched its “Control Your Diabetes. For Life.” awareness campaign in 1998. The campaign was designed to educate the millions of Americans with diabetes and their social supporters about the seriousness of diabetes, ways to control the disease, and the benefits of good glucose control. The NDEP conducted extensive audience research and applied behavior change theories and the social marketing framework to design, implement, and evaluate the campaign. From 1998 to 2003, the campaign achieved at least 700 million media impressions with its culturally appropriate television and radio public service announcements, print ads, and newspaper and magazine stories. In addition, over half of people with diabetes indicated awareness of the campaign and NDEP has tracked positive trends in practice of blood glucose testing and awareness of the A1C (also known as the hemoglobin A1C), the best measure of blood glucose control, since the campaign's launch.

In vitro studies of eggplant ( Solanum melongena) phenolics as inhibitors of key enzymes relevant for type 2 diabetes and hypertension

National Diabetes Education Program of NIH, Mayo Clinic and American Diabetes Association recommend eggplant-based diet as a choice for management of type 2 diabetes. The rationale for this suggestion is the high fiber and low soluble carbohydrate content of eggplant. We propose that a more physiologically relevant explanation lies in the phenolic-linked antioxidant activity and α-glucosidase inhibitory potential of eggplant which could reduce hyperglycemia-induced pathogenesis. Results from this study indicate that phenolic-enriched extracts of eggplant with moderate free radical scavenging-linked antioxidant activity had high α-glucosidase inhibitory activity and in specific cases moderate to high angiotensin I-converting enzyme (ACE) inhibitory activity. Inhibition of these enzymes provide a strong biochemical basis for management of type 2 diabetes by controlling glucose absorption and reducing associated hypertension, respectively. This phenolic antioxidant-enriched dietary strategy also has the potential to reduce hyperglycemia-induced pathogenesis linked to cellular oxidation stress. These results provide strong rationale for further animal and clinical studies.

Role of Food and Nutrition Professionals in Stemming the Diabetes Epidemic

Food and nutrition professionals can play a major role in reversing the diabetes epidemic by helping patients reduce their risk for diabetes and prevent its onset. The Diabetes Prevention Program (DPP) clinical trial, spearheaded by the National Institutes of Health, has provided the research-based evidence needed to demonstrate that type 2 diabetes can be delayed or prevented through a 5% to 7% weight loss and regular physical activity, such as 150 minutes a week of brisk walking. The National Diabetes Education Program, through its “Small Steps. Big Rewards. Prevent Type 2 Diabetes” initiative, has translated the lifestyle intervention used in the DPP for health care professionals. The initiative includes a health care professional toolkit, user-friendly weight-loss materials for patients, and a mass media campaign to increase awareness that diabetes can be delayed or prevented. Food and nutrition professionals can access these materials free of charge online or through the National Diabetes Education Program clearinghouse. By applying the lessons learned from the DPP to patients at risk for diabetes, food and nutrition professionals can make a substantial contribution to reversing the diabetes epidemic.

Message from Griffin P. Rodgers, M.D., M.A.C.P., Director, NIDDK, on the Institute’s Obesity Research

Message from Griffin P. Rodgers, M.D., M.A.C.P., Director, NIDDK, on the Institute’s Obesity Research

Reducing cardiovascular disease risk in patients with diabetes: A message from the National Diabetes Education Program

To provide nurse practitioners (NPs) a review of current practice guidelines that help clinicians' efforts to reduce the morbidity and mortality associated with diabetes and its major macrovascular complications. This paper presents data from major evidence-based studies and clinical trials that define the scope of the problem, the rationale for risk reduction, and a patient-centered action plan for NPs to effectively manage cardiovascular risk factors in people with diabetes. NPs are active partners with the National Diabetes Education Program and play a key role in efforts to effectively manage cardiovascular risk factors in people with diabetes and improve their awareness of the link between diabetes and heart disease and stroke. The action plan to reduce cardiovascular risk in people with diabetes will help NPs to implement the most effective management strategies for medical nutrition therapy, physical activity, and pharmacological therapy required for patient-centered proactive management of hyperglycemia, hypertension, and lipid abnormalities.

Changing the Way Diabetes is Treated With Information and Resources

T he U.S. Department of Health and Human Services' National Diabetes Education Program (NDEP) is the leading federal government public education program that promotes diabetes prevention and control. Based on the scientific results of the Diabetes Control and Complications Trial,1 NDEP was launched in 1997 with a mission to reduce the morbidity and mortality associated with diabetes. To fulfill that mission, NDEP translates the latest science and disseminates the message that type 2 diabetes is serious, common, and costly, yet controllable and preventable. NDEP is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, with the support of > 200 partner organizations. Health care professionals need to know about current advances in diabetes management and prevention and require access to the most appropriate and effective tools and materials to assist them in administering the most effective care. NDEP provides a wealth of information and tools through three major campaigns: 1. Control Your Diabetes. For Life. This is a comprehensive information campaign focusing on tips and strategies for effective diabetes management. 2. Be Smart About Your Heart: Control the ABCs of Diabetes. This emphasizes the link between diabetes and cardiovascular disease. 3. Small Steps. Big Rewards. Prevent Type 2 Diabetes. This is the first national diabetes prevention effort. In view of the spiraling epidemic of diabetes in …

Helping the Student With Diabetes Succeed: A Guide for School Personnel Now Available From the National Diabetes Education Program

Helping the Student With Diabetes Succeed: A Guide for School Personnel Now Available From the National Diabetes Education Program

The goals of comprehensive and integrated disease state management for diabetic kidney-disease patients

Diabetes, cardiovascular disease, and chronic kidney disease present many challenges to clinicians as separate disease entities. Management and optimization of care of diabetic kidney-disease patients requires a proactive and integrated approach for all 3 disease states. To optimize the assessment, monitoring, and intervention in this population, comprehensive and integrated disease state management medical care plans must be established. Medical nutrition therapy is another key component that must be coordinated with these disease-state management medical care plans. Coordination of integrated disease-state management and medical nutrition therapy for diabetes, cardiovascular disease, and chronic kidney disease will help to improve patient outcomes and allow for a proactive approach to the identification, prevention, and management of potential disease-state complications. Several programs and guidelines have been established to accomplish these goals: the K/DOQI Clinical Practice Guidelines, the American Diabetes Association Standards of Medical Care for Diabetes (developed by the American Diabetes Association, the National Institute of Diabetes and Digestive Kidney Diseases, and the Centers for Disease Control-Diabetes Foundation), the National Diabetes Education Program, and the National Cholesterol Education Program. The multidisciplinary medical care team assumes an integral role in the success and implementation of this integrated approach as well as the empowerment of the patient in their own care.

Diabetes Clinical Trials: What Is New at NIDDK?

C ontrolled, randomized clinical trials are the foundation on which the American Diabetes Association (ADA) and other groups develop guidelines for diabetes care. The Diabetes Control and Complications Trial (DCCT)1 provided definitive evidence that intensive glycemic control dramatically reduces the microvascular complications of type 1 diabetes. The United Kingdom Prospective Diabetes Study2 provided similar findings for type 2 diabetes. The results of these trials formed the basis for ADA's current standards of care and led the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Centers for Disease Control and Prevention (CDC) to create the National Diabetes Education Program (NDEP) to disseminate the new guidelines to providers and patients.3 As additional clinical trials demonstrated the importance of blood pressure and LDL cholesterol control in preventing vascular complications of diabetes, the NDEP expanded its focus to the “ABCs of diabetes”: A 1C, B lood pressure, and C holesterol. More recently, the Diabetes Prevention Program demonstrated that a 5-7% weight loss and modest physical activity (30 minutes a day, 5 days a week) reduced the development of type 2 diabetes by 58% over 2.8 years.4 In response, the NDEP launched its “Small Steps. Big Rewards. Prevent Type 2 Diabetes.” campaign, providing patients and providers with tools for lifestyle change. Additional information about this program is available at the NDEP Web site (www.ndep.nih.gov). There are often significant differences between trials supported by industry and those supported with public funds. The nature of the intervention under study is one consideration. It is noteworthy that the seminal DCCT did not focus on specific medications and thus would not have been undertaken by industry. Another consideration is the size of the group affected by a disease. While there is a large and unfortunately rapidly expanding market for type …

An update on type 2 diabetes in youth from the National Diabetes Education Program.

An update on type 2 diabetes in youth from the National Diabetes Education Program.

Type 2 Diabetes and its Association with Hypertension and Depression in an Iraqi Population

The association of type 2 diabetes mellitus and hypertension is so high that it cannot be explained on the basis of diabetic nephropathy. This phenomenon has been attributed to a condition known as metabolic syndrome. Depression may be another aspect of metabolic syndrome. We conducted a cross-control study with 110 patients with type 2 diabetes mellitus (DM) and 110 control subjects of comparable age and sex. We determined the time since diagnosis of diabetes, the presence of hypertension (HT), coronary heart disease, cerebrovascular insufficiency, and depression, and took several anthropometric measurements, including height, weight, body mass index (BMI) waist circumference (WC), waist-to-hip circumference ratio (WHR), triceps skin fold thickness (TSFT), mid-upper arm circumference (MUAC), and mid-upper arm muscle area (MAMA). We also investigated depression in metabolic syndrome by comparing patients with type 2 diabetes alone and with type 2 diabetes and hypertension who attended a diabetes clinic. The prevalence of depression in hypertensive diabetics was 57% whereas in diabetics alone it was 40% (X2=4.3, P is less than 0.05). Likewise, combined hypertension and depression was more common among diabetics than controls (66% vs 25% respectively P is less than 0.01). The presence of combined hypertension and type 2 diabetes should alert the clinician to look for other features of the metabolic syndrome and for associated depression, which should be treated in most cases by pharmacotherapy.

National diabetes education program: teaming up to prevent diabetes and its complications.

National diabetes education program: teaming up to prevent diabetes and its complications.

Type 2 diabetes in children and adolescents: information from the National Diabetes Education Program.

Type 2 diabetes in children and adolescents: information from the National Diabetes Education Program.

Promoting early diagnosis and treatment of type 2 diabetes: the National Diabetes Education Program.

DIABETES MELLITUS EXACTS AN ENORMOUS TOLL IN the United States by decreasing quality of life and causing death and disability, all at a huge economic cost. Yet simple diagnostic criteria and effective treatment choices that prevent or delay the onset of costly diabetes complications are readily available to health care professionals. It is time for health care professionals and patients with diabetes to take action together to reduce premature morbidity and mortality from diabetes-caused disease. The National Diabetes Education Program is the first joint diabetes initiative of the National Institutes of Health and the Centers for Disease Control and Prevention and involves public and private partnerships to promote early diagnosis and improve the treatment and outcomes for patients with type 1 and type 2 diabetes mellitus. It is estimated that in the United States, type 2 diabetes can be present for up to 9 to 12 years before initial clinical diagnosis. Microvasculardiseaseprogressesduringthis time,causing 15% to 20% of patients to have retinopathy and 5% to 10%tohaveproteinuriaat the timeofdiagnosis. Patientswith type 2 diabetes have high rates of hypertension, dyslipidemia, and obesity, major reasons for their 2to 4-fold higher rates ofcardiovasculardisease. Type2diabetes isoccurring increasingly in younger people. Although every patient can be expected to benefit from any increment in improved glycemic control, blood glucose control is more effective in preventing the initial development of microvascular complications than inpreventing theprogressionofcomplicationsonce theyhave become established. This finding underscores the need for aggressive treatment as soon as type 2 diabetes is diagnosed. Diabetes accounts for almost $100 billion in direct medical costs and indirect expenditures attributable to diabetes each year. Further, while patients with diabetes represented 4.5% of the US population in 1992, they accounted for 15% of total US health care expenditures and 27% of Medicare expenditures. There is a marked correlation between glycemic control of diabetes as measured by glycosylated hemoglobin (HbA1c) testing and the cost of medical care. Medical care charges increase significantly for every 1% increase in HbA1c level above 7%. In 1994, excess expenditures for patients with diabetes in a managed care setting totaled $282.7 million or $3494 per person—2.4 times the cost for control subjects. Nearly 38% of the total excess was spent treating the long-term complications of diabetes, predominantly coronary heart disease and end-stage renal disease. Because of its high and increasing prevalence, type 2 diabetes contributes a significant portion of these costs. There is substantial evidence that the human and economic burden of diabetes can be reduced significantly by early, aggressive therapeutic intervention. The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that intensive blood glucose control for patients with type 1 and type 2 diabetes significantly reduced the risk for retinopathy, nephropathy, and neuropathy. Lowering blood pressure in a subset of UKPDS patients to a mean of 144/82 mm Hg reduced the risk of strokes, diabetes-related deaths, heart failure, microvascular complications, and vision loss

Blood Glucose Laboratory for First-year Medical Students: An Interdisciplinary Model for Nutrition-focused Diabetes Management

Reducing the morbidity and mortality associated with diabetes continues to be a challenging problem (1,2). Education of the individual with diabetes is a large component of that challenge. As 1 of 4 objectives, the National Diabetes Education Program includes promotion of a team approach to diabetes care (1). The value of the registered dietitian to the health care team for diabetes management has been demonstrated (3–5).