Dietitians play essential role in effective management of Type 1 and Type 2 diabetes in adults

ScienceDaily (Nov. 23, 2010) ? Proper nutrition therapy is essential for the successful management of type 1 and type 2 diabetes and registered dietitians (RDs) can play a key role as part of the health care team. An article in the December issue of the Journal of the American Dietetic Association reviews the evidence and nutrition practice recommendations presented in the American Dietetic Association Nutrition Practice Guidelines for Type 1 and Type 2 Diabetes in Adults. This complete and systematic review presents 29 key nutrition practice guidelines in order to best support people with diabetes.

According to Marion J Franz, MS, RD, lead author and noted nutrition consultant, "This publication has reviewed the process for developing the guidelines, identified major and contributing factors for diabetes nutrition therapy, reviewed and summarized research, and stated the nutrition practice recommendations that are to be integrated into the nutrition care process. The nutrition practice guidelines provide recommendations for assessing client/patient needs and for selecting interventions, monitoring and evaluating outcomes. The evidence is strong that medical nutrition therapy provided by RDs is an effective and essential therapy in the management of diabetes. RDs are uniquely skilled in this process."

The authors conducted a thorough review of the research literature to distill evidence-based nutrition recommendations and practice guidelines regarding the major nutrition therapy factors -- carbohydrates (intake, sucrose, non-nutritive sweeteners, glycemic index, fiber), protein intake, cardiovascular disease, and weight management. Armed with information regarding what works and why, RDs can encourage lifestyle changes and select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data.

Key recommendations:

Consistency in day-to-day carbohydrate intake for persons with type 2 diabetesAdjusting insulin dose to match carbohydrate intake for persons with type 1 diabetesFocusing on total carbohydrate intake rather than the type of carbohydrateCardio protective nutrition interventionsWeight management strategiesRegular physical activityUse of self glucose monitoring data to determine if goals are being met

The article is "The Evidence for Medical Nutrition Therapy for Type 1 and Type 2 Diabetes in Adults" by Marion J Franz, MS, RD; Margaret A Powers, PhD, RD; Carolyn Leontos, MS, RD; Lea Ann Holzmeister, RD; Karmeen Kulkarni, MS, RD; Arlene Monk, RD; Naomi Wedel, MS, RD; and Erica Gradwell, MS, RD. It appears in the Journal of the American Dietetic Association, Volume 110 Issue 12 (December 2010) published by Elsevier.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier, via EurekAlert!, a service of AAAS.

Journal Reference:

Marion J Franz, MS, RD; Margaret A Powers, PhD, RD; Carolyn Leontos, MS, RD; Lea Ann Holzmeister, RD; Karmeen Kulkarni, MS, RD; Arlene Monk, RD; Naomi Wedel, MS, RD; and Erica Gradwell, MS, RD. The Evidence for Medical Nutrition Therapy for Type 1 and Type 2 Diabetes in Adults. Journal of the American Dietetic Association, Volume 110 Issue 12 (December 2010)

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Registered Dietitians Play Essential Role In Effective Management Of Type 1 And Type 2 Diabetes In Adults

Main Category: Diabetes
Also Included In: Nutrition / Diet
Article Date: 21 Nov 2010 - 0:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Proper nutrition therapy is essential for the successful management of type 1 and type 2 diabetes and registered dietitians (RDs) can play a key role as part of the health care team. An article in the December issue of the Journal of the American Dietetic Association reviews the evidence and nutrition practice recommendations presented in the American Dietetic Association Nutrition Practice Guidelines for Type 1 and Type 2 Diabetes in Adults. This complete and systematic review presents 29 key nutrition practice guidelines in order to best support people with diabetes.

According to Marion J Franz, MS, RD, lead author and noted nutrition consultant, "This publication has reviewed the process for developing the guidelines, identified major and contributing factors for diabetes nutrition therapy, reviewed and summarized research, and stated the nutrition practice recommendations that are to be integrated into the nutrition care process. The nutrition practice guidelines provide recommendations for assessing client/patient needs and for selecting interventions, monitoring and evaluating outcomes. The evidence is strong that medical nutrition therapy provided by RDs is an effective and essential therapy in the management of diabetes. RDs are uniquely skilled in this process."

The authors conducted a thorough review of the research literature to distill evidence-based nutrition recommendations and practice guidelines regarding the major nutrition therapy factors - carbohydrates (intake, sucrose, non-nutritive sweeteners, glycemic index, fiber), protein intake, cardiovascular disease, and weight management. Armed with information regarding what works and why, RDs can encourage lifestyle changes and select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data.

Key recommendations:

- Consistency in day-to-day carbohydrate intake for persons with type 2 diabetes
- Adjusting insulin dose to match carbohydrate intake for persons with type 1 diabetes
- Focusing on total carbohydrate intake rather than the type of carbohydrate
- Cardio protective nutrition interventions
- Weight management strategies
- Regular physical activity
- Use of self glucose monitoring data to determine if goals are being met

The article is "The Evidence for Medical Nutrition Therapy for Type 1 and Type 2 Diabetes in Adults" by Marion J Franz, MS, RD; Margaret A Powers, PhD, RD; Carolyn Leontos, MS, RD; Lea Ann Holzmeister, RD; Karmeen Kulkarni, MS, RD; Arlene Monk, RD; Naomi Wedel, MS, RD; and Erica Gradwell, MS, RD. It appears in the Journal of the American Dietetic Association, Volume 110 Issue 12 (December 2010) published by Elsevier.

In an accompanying podcast interview lead author Marion J Franz, MS, RD, and Kari Kren, MPH, RD, LD, Manager, Evidence-based Practice, Research & Strategic Business Development, ADA, discuss the importance and implications of "The Evidence for Medical Nutrition Therapy for Type 1 and Type 2 Diabetes in Adults." It is available here.

Source:
American Dietetic Association
Elsevier

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Non-invasive Glucose Measurements In The Eye Highly Effective In Clinical Study

Main Category: Eye Health / Blindness
Also Included In: Diabetes
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Freedom Meditech, Inc., the developer of non-invasive, ophthalmic-based products to detect and manage diabetes, today announced results of a clinical study that showed a high correlation between low to high blood glucose levels and non-invasive glucose measurements in the eye in a live animal model.

Results of the study of Freedom Meditech's I-SugarX™, non-invasive glucose monitoring system were presented at the Diabetes Technology Meeting in Bethesda, Maryland.

The study showed that the I-SugarX™ non-invasive polarimetric based measurements of glucose in the aqueous humor of eye tracked glucose measurements in the blood with 93 percent of readings in the A zone and the remaining seven percent in the B zone of the Clarke Error Grid (CEG). The CEG is a "gold standard" for determining the accuracy of glucose measurements - with zones A and B designated as acceptable for therapy decisions. No data fell outside the acceptable zones. The reference glucose sensors used in the study were the Johnson and Johnson LifeScan One Touch Ultra glucose meter and the Yellow Springs Instrument glucose analyzer. Seven New Zealand White rabbits were tested in the study with 41 data points collected over average study durations of 60 minutes. The average time delay between blood glucose readings and ocular readings was less than four minutes.

"The eye can be thought of as an optical window into to body for the painless measurement of glucose in the ocular fluid as opposed to the blood, and is well suited for our proprietary optical polarimetric based measurements," said John F. Burd, Ph.D., Chief Science Officer of Freedom Meditech. "Based on the results of this, and other studies, we plan to begin human clinical studies as we continue our product development."

The I-SugarX™ is a non-invasive, handheld, ocular glucose measurement device that is intended to provide people with diabetes a convenient, pain-free, and bloodless way to monitor daily glycemic control. The I-SugarX™ aims to become a superior alternative to the current "finger prick" glucose monitoring test. The global market for diabetes glucose monitoring is estimated to be $12 billion annually.

Source:
Freedom Meditech

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posted by Asha Swarup on 17 Nov 2010 at 1:11 am

The article mentions a handheld device but exactly what do you do with it to measure ocular glucose levels? It is an eyepiece to place over your eye for a few minutes? Do you look into the instrument? It would have been useful to include a description in this article. Still, it's exciting news. Thanks.

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Clinical trials demonstrate effective weight loss strategies for obese and overweight adults

ScienceDaily (Oct. 13, 2010) ? Lifestyle interventions, including physical activity and structured weight loss programs, can result in significant weight loss for overweight, obese and severely obese adults, according to two reports that were posted online by JAMA. The articles will appear in the October 27 print issue of JAMA.

According to background information in the papers, obesity is among the most significant public health problems of the 21st century and the prevalence of obesity has been rapidly rising for the past three decades, especially among African American women. National statistics indicate that the prevalence for overweight and obesity combined (having a body mass index of 25 or greater) is 68 percent of the population. Both papers note the increased risk of numerous other medical problems for people who are overweight or obese, including diabetes and high blood pressure. The authors also point out the lack of scientific evidence for most weight loss programs or evidence-based treatment guidelines, particularly for severe obesity.

In a one-year intensive lifestyle intervention study of diet and physical activity, Bret H. Goodpaster, Ph.D., from the University of Pittsburgh School of Medicine and colleagues, randomized a group of 130 severely obese adult individuals without diabetes in two groups to assess weight loss for a period of one year. One group was randomized to diet and physical activity for the entire 12 months, while the other group had the identical dietary intervention, but with physical activity delayed for six months. The study was conducted from February 2007 with follow-up through April 2010.

"To facilitate dietary compliance and improve weight loss, liquid and pre-packaged meal replacements were provided at no cost for all but one meal per day during months one through three and for only one meal replacement per day during months four through six of the intervention," the authors report. The physical activity component included brisk walking up to 60 minutes, five days a week. Participants were provided with a pedometer and encouraged to walk at least 10,000 steps a day. Small financial incentives for adherence to the behavioral goals of the intervention were also provided. The participants received a combination of group, individual and telephone contacts as part of the lifestyle intervention.

"Of 130 participants randomized, 101 (78 percent) completed the 12-month follow-up assessments," the authors state. The group that started with the diet and physical activity lost more weight in the first six months than the delayed-activity group (about 24 pounds as compared to 18 pounds). However, the authors report that weight loss at 12 months was about the same in the two groups (almost 27 pounds versus about 22 pounds). "Waist circumference, visceral abdominal fat, hepatic (liver) fat content, blood pressure and insulin resistance were all reduced in both groups," according to the authors.

"In conclusion, intensive lifestyle interventions using a behavior-based approach can result in clinically significant and meaningful weight loss and improvements in cardiometabolic risk factors in severely obese persons. It is also clear that physical activity should be incorporated early in any dietary restriction approach to induce weight loss and to reduce hepatic steatosis [fatty liver] and abdominal fat. Our data make a strong case that serious consideration should be given by health care systems to incorporating more intensive lifestyle interventions similar to those used in our study. Additional studies are clearly needed to determine long-term efficacy and cost-effectiveness of such approaches."

This study was funded by the Commonwealth of Pennsylvania Department of Health. Co-author Jolene Brown, M.D., was supported by a National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant.

Editorial: The State of Obesity and Obesity Research

"Class II obesity (body mass index [BMI] of more than 35) and class III obesity (BMI of 40 or more) is a prevalent condition that adversely affects health," according to Donna H. Ryan, M.D. of Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, and Robert Kushner, M.D., M.S., of Northwestern University Feinberg School of Medicine, Chicago, in an accompanying editorial.

"Severe obesity is a prevalent public health problem, disproportionately affecting women and minorities. There is still much to learn about the mechanisms underlying differing risk and treatment outcomes between populations. Optimal treatment approaches for class II and class III obesity are underexplored, while payment approaches for interventions known to work have yet to be adopted."

"Additional rigorous research, such as the clinical trial by Goodpaster et al, are needed to unravel the causes, identify prevention strategies, and develop the best treatments for obesity," they conclude.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal References:

B. H. Goodpaster, J. P. DeLany, A. D. Otto, L. Kuller, J. Vockley, J. E. South-Paul, S. B. Thomas, J. Brown, K. McTigue, K. C. Hames, W. Lang, J. M. Jakicic. Effects of Diet and Physical Activity Interventions on Weight Loss and Cardiometabolic Risk Factors in Severely Obese Adults: A Randomized Trial. JAMA: The Journal of the American Medical Association, 2010; DOI: 10.1001/jama.2010.1505D. H. Ryan, R. Kushner. The State of Obesity and Obesity Research. JAMA: The Journal of the American Medical Association, 2010; DOI: 10.1001/jama.2010.1531

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