Anne Daly

Evolution of diabetes medical nutrition therapy

Research supports the importance of medical nutrition therapy in achieving diabetes treatment goals. For persons requiring insulin therapy, the first priority is to integrate an insulin regimen into the patient’s lifestyle. For type 2 diabetes, the priority is to focus on lifestyle strategies (that is, nutrition and exercise) that will improve metabolic outcomes at diagnosis and as the disease progresses. Patients with diabetes need nutrition recommendations that are supported by scientific evidence and that can be easily understood and translated into everyday life. To achieve positive outcomes, a coordinated team effort that provides continued education and support is essential.

The new credential: advanced diabetes management.

A new multidisciplinary credential, the advanced diabetes manager, has been developed by the American Association of Diabetes Educators (AADE) and the American Nurses Credentialing Center (ANCC), in collaboration with the American Dietetic Association, the American Diabetes Association, and the American Pharmaceutical Association (APhA). The credential, designated as BC-ADM, is conferred upon successful completion of an exam to registered dietitians, registered nurses and registered pharmacists who hold advanced degrees and meet experience requirements. The exam is based on the scope and standards of practice approved by the governing agencies of the sponsoring organizations and defines advanced diabetes management knowledge and skills associated with improved outcomes. Information related to the test content outline, application process, suggested exam preparation, test sites, etc., is available from www.aadenet.org or www.nursingworld.org/ancc.

Advanced practice care in diabetes.

Today is a remarkable time in diabetes care. Diabetes has reached epidemic proportions worldwide. An estimated 17 million Americans have this deadly disease, while another 16 million have pre-diabetes, or impaired glucose tolerance (IGT). With the aging of the U.S. population and our increasing life expectancy, the demand for diabetes care is only expected to increase. Recognition is growing that diabetes is a serious disease and a major contributor to escalating health care costs. The costs of the disease as well as concerns about access to quality diabetes care are making diabetes a national priority. At the same time, diabetes care has become increasingly sophisticated. Diabetes research has resulted in newer insulins and medications, better systems for insulin delivery and self-monitoring of blood glucose, and more aggressive treatment of diabetes complications and comorbid conditions. Clinical care of diabetes has more treatment options than ever before, and many more are in the pipeline. Simultaneously, changes in the health care system and public policy have shifted diabetes treatment from acute care settings, such as hospitals, toward outpatient facilities and managed care organizations. The drive to identify cost-effective treatment is intense. Increasingly, health care professionals who specialize in the care of people with chronic illnesses such as diabetes are increasingly recognized as an important group. A greater focus on health promotion and prevention is increasingly evident. Diabetes health care providers seek to expand their niche in today’s health care environment. The team approach to diabetes care has long been advocated, and the benefits of a team approach to diabetes management have been well documented.1–4 Still another driving force in diabetes care today is the changing face of the American public. As baby boomers join the ranks of the “elderly,” consumers continue to become more knowledgeable, more politically active, and more insistent about the health care they receive. Consumers want quality care that is accessible and cost-effective. These factors and others have set the stage for significant changes in how diabetes care has been provided over the past decade. Most disciplines involved in diabetes care have developed professional practice standards for diabetes, and standardized outcome measurement tools have been developed and are in use. Indeed, diabetes care has developed into a highly specialized field with an emerging trend toward advanced practice-level care—the topic of this From Research to Practice section.

Assessing Long Term Weight Maintenance Results

Abstract A retrospective analysis was performed on all patients active in the maintenance phase (n=82) of the weight management/behavior change education program at the Springfield Diabetes & Endocrine Center in November 1998, to evaluate success in losing weight and maintaining weight loss. Three methods for weight loss were used: very low calorie diets (520kcal/day) (HMR™500) for morbidly obese, low calorie diets (800kcal/day)(HMR™800) for patients at minimal health risk, and moderate calorie deficit diets. Patients attended weekly group classes conducted by registered dietitians, which emphasized physical activity, calories, low rat cooking, environmental control, Failure Syndrome™ issues, and self-management of weight. All staff are trained and skilled in teaching the Health Management Resources (HMR™) behavioral change education program. All patients attended a minimum of 6 months of weekly one hour maintenance classes, while high risk morbidly obese patients attended a minimum of 18 months of classes. 59% patients had voluntarily chosen to extend their initial maintenance contract period of service. 57% patients were at least 2 years in maintenance, while 26% were beyond 5 years. Average weight loss of all patients (n=82) was 64lbs. & 27% of initial body weight. Average % initial body weight being kept off is 21%. Patients beyond 2 years in maintenance (n=40) lost an average of 75lb., equal to 13% initial body wt Patients beyond 5 years in maintenance (n=21) lost an average of 80 lbs. and are maintaining wt. loss equal to 15% initial body wt. Authors conclude it is possible to get patients to attend behavior change education classes regularly even after 5 years in maintenance. Participation in the HMR™ maintenance program enables patients to keep off significant amounts of weight. It appears mat periods of non-participation in maintenance affect weigjht maintenance adversely.

Assessing Outcomes of Lifestyle Change Education

Abstract A retrospective analysis was performed on 64 patients enrolled in an 8 week HMR™ Healthy Solutions™ lifestyle change class. Average start weight was 225 lbs. Some patients were at increased medical risk due to presence of co-morbid conditions while others had no major medical problems other than obesity. Two hour weekly classes were taught by registered dietitians with special training in weight management. Patients were instructed to follow a calorie deficit diet and increase physical activity to promote weight loss. Patients were asked to consume 3 servings daily of HMR™ 120 (liquid meal replacements), plus 2 well balanced meals and snacks, including plenty of fruits and vegetables, for a total of at least 1200 calories. Education focused on calorie counting, record keeping, physical activity, environmental control, and Failure Syndrome™ Patients lost an average of 14 lbs. or 6.5% initial body weight over 7 weeks. 97% used ≥2 servings HMR™ 120 daily. 28% did ≥2000 calories physical activity weekly. 84% consumed ≥21 (1 cup) servings of fruits and vegetables per week, while 25% consumed ≥ 34 servings per week. 68% joined a 6 month maintenance program, while 12% participated in an extended (beyond 6 months) maintenance program. 69% of those who participated in maintenance lost additional weight, for an average of 6 lbs. additional weight loss. Average total weight loss for all patients (n=64) at the end of 6 months was 16 lbs., or 7% of initial body weight. Authors conclude weekly education group classes are effective in changing lifestyle behaviors and to accomplish medically significant weight loss.