The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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6 Diabetes Mellitus
6 Diabetes Mellitus
Pages 118-131
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From page 118... ...
The microvascular complications include retinopathy, nephropathy, and neuropathy. The macrovascular complications include coronary artery disease, peripheral vascular disease with amputation, stroke, and renal disease.
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From page 119... ...
Diabetes Control and Complications Trial Investigators in the Diabetes Control and Complications Trial (DCCT) , a randomized controlled trial, followed 1,400 patients with type 1 diabetes, between the ages of 15 and 39 years, for 7 years to determine what effect normalizing blood glucose and HbA~C had on chronic complications of the disease (DCCT Research Group, 1993~.
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From page 120... ...
The mean age was 60 + 6 years and the length of diagnosis of noninsulin-dependent diabetes mellitus was 7.8 + 4.0 years. While the standard treatment was one injection each morning, intensive insulin therapy was a stepped plan with up to multiple insulin injections as necessary to attain near normal glycemia.
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From page 121... ...
any diabetes-related end point (sudden death, death from hyperglycemia or hypoglycemia, fatal or nonfatal myocardial infarction, angina, heart failure, stroke, renal failure, amputation, vitreous hemorrhage, retinopathy requiring photocoagulation, blindness in one eye, or cataract extraction)
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From page 122... ...
Overall, evidence from many types of studies involving nutrition therapy in the management of diabetes is supportive of nutrition intervention. The American Diabetes Association has recognized the value of medical nutrition therapy and considers it an essential component of diabetes management (American Diabetes Association, l999b)
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From page 123... ...
Adjusting food and/or insulin resulted in significantly lower HbA~C levels. This substudy on 687 patients provides evidence that dietary behaviors positively alters indicators of glycemic control when used in combination with appropriate insulin management (Delahanty and Halford, 1993~.
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From page 124... ...
Diabetes education and social support were provided by an interdisciplinary team consisting of a clinical nurse specialist, a dietitian, both of whom were certified diabetes educators (ODE) , and a social worker.
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From page 125... ...
Both of these studies demonstrate that regardless of the intensity of the nutrition intervention, improvements in blood glucose levels can be achieved with nutrition therapy. In addition, these studies indicate that when practice guidelines are used, increasing the intensity of the nutrition therapy by both time spent and the number of visits, greater improvements in glycemic control result.
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From page 126... ...
has recommended that a registered dietitian, knowledgeable and skilled in implementing nutritional interventions, be the team member providing nutrition education. In addition, the American Diabetes Association (1999c)
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From page 127... ...
As of October 1999, nationwide there were a total of 978 diabetes selfmanagement education programs sites recognized by the American Diabetes Association. There are, however, widespread rural areas in which access to approved diabetes self-management training is severely limited.
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From page 128... ...
LIMITATIONS OF DATA AND FUTURE RESEARCH NEEDS Although a number of studies support the usefulness of nutrition therapy in helping patients attain better control of diabetes and improving outcomes, the number of randomized, controlled trials that specifically explore this question are few. In addition, most of these studies involve nutritional intervention as part of an overall team approach to diabetes education.
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From page 129... ...
Although nutrition therapy is best carried out when a patient is first diagnosed, it appears to be effective at any time during the disease process and refresher therapy may be of value. The American Diabetes Association, other national diabetes organizations, and the World Health Organization all support a recommendation for nutrition therapy in patients with diabetes mellitus.
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From page 130... ...
1993. Intensive treatment safely improves glycemic control of elderly patients with diabetes mellitus.
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From page 131... ...
1995. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study.
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