Karmeen Kulkarni

The Evidence for Medical Nutrition Therapy for Type 1 and Type 2 Diabetes in Adults

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Associations nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can 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. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.

Determining the Efficacy of a Resiliency Training Approach in Adults With Type 2 Diabetes

PURPOSE The purpose of this randomized clinical study was to test the efficacy of a resiliency training approach for people with diabetes who have previously received standard diabetes self-education. METHODS A single-blinded, randomized design was employed with repeated measures (baseline, 3 months, 6 months) with 67 participants assigned to either treatment as usual (n = 37) or the resiliency classes (n = 30). Outcome variables included physiological measures (glycosylated hemoglobin, waist measurement, eating and exercise habits) and psychosocial measures (self-efficacy, locus of control, social support, and purpose in life). RESULTS Analyses of variance indicated that the intervention group had higher levels of resiliency as reported by knowing positive ways of coping with diabetes-related stress, knowing enough about themselves to make right diabetes choices, having fun in life, eating healthier, and increasing physical activity compared with the control group at 3 months (P < .05). Glycosylated hemoglobin and waist measurement improved but not significantly. CONCLUSIONS Interventions to foster resilience among people with diabetes have the potential to make an important contribution to increasing positive life outcomes. Diabetes educators using the resiliency approach in tandem with standard diabetes education programs can assist their patients to become more self-directed in their diabetes care.

Management of Type 2 Diabetes: Oral Agents, Insulin, and Injectables

This article highlights the use of antidiabetic agents, including insulin. Medical nutrition therapy (MNT) and physical activity are the cornerstones of management of type 2 diabetes. The progressive nature of type 2 diabetes requires use of one or more oral agents and eventually insulin, along with MNT and physical activity. The American Association of Clinical Endocrinologists and the European Association for the Study of Diabetes have recommended a lower hemoglobin A1c target of <6.5%, and many health care providers strive to achieve normalization of blood glucose. Achievement of these goals often prompts providers to consider combination therapy to target different pathogenic mechanisms and manage both fasting and postprandial blood glucose levels. Maintenance of glycemic control over the lifespan of a patient with diabetes is overwhelmingly likely to require combination therapy with oral diabetes medications. The UK Prospective Diabetes Study reported that <50% of patients maintained glycemic control on MNT or monotherapy with oral agents at 3 years, and that number dropped to <25% at 9 years. Newer agents and insulins have become available since the UK Prospective Diabetes Study was completed and have enhanced our armamentarium of therapeutics for treatment of diabetes.

Evolving roles: from diabetes educators to advanced diabetes managers.

Virginia Valentine, CNS, BC-ADM, CDE; Karmeen Kulkarni, MS, RD, BC-ADM, CDE; and Debbie Hinnen, ARNP, BC-ADM, CDE The evolution of advanced practice in diabetes management has emulated the advanced practice efforts of nursing groups. However, many disciplines are involved in the care and education of people with diabetes. This article reviews the expanded role of health professionals in diabetes and describes the development of a new clinical management credential for nurses, dietitians, and pharmacists with advanced degrees and advanced practice experience in diabetes.

Is It Safe to Consume Aspartame During Pregnancy? A Review

if it is safe for pregnant women to include aspartame as a nonnutritive sweetener in the diet. This question has become increasingly pertinent with the widespread use of aspartame in food products, and in light of occasional media reports of possible harmful effects of aspartame. Before the question concerning the use of aspartame during pregnancy can be answered, two other issues must first be examined: expected intake of aspartame, and the metabolism of aspartame and the fate of its metabolic products. Data from studies of these two issues form the basis for recommendations regarding the use of aspartame during pregnancy.

Thriving with diabetes: an introduction to the resiliency approach for diabetes educators.

PURPOSE The purpose of this article is to introduce the resiliency counseling approach for people with type 2 diabetes, which can be used to enhance standard diabetes education programs. Why do some people with type 2 diabetes thrive in the face of adversity and disruption while others remain apathetic or succumb to destructive behaviors? Many researchers focus on the risk factors and barriers to diabetes management rather than explore the resilient qualities that keep people thriving. Optimal diabetes care requires an emotionally healthy patient. METHODS A review of the available literature on resilience and resiliency theory is included. Resiliency is defined as the experience of being disrupted by change, opportunities, adversity, stressors, or challenges and, after some disorder, accessing personal gifts and character strengths to grow stronger through the disruption. RESULTS Research in a diabetes population suggests that resiliency training in addition to standard diabetes education in people with type 2 diabetes improved coping with diabetes-related stress, having fun in life, helping others, and feeling trustworthy. CONCLUSIONS Psychosocial and physiological improvements can help people with diabetes thrive instead of succumb to despair. Interventions to foster resilience among people with type 2 diabetes have the potential to make an important contribution to reducing the risk of complications and increasing positive life outcomes. Diabetes educators using the resiliency approach in tandem with standard diabetes education programs can assist people with type 2 diabetes to become more self-directed in their diabetes care.

Is Aspartame Safe

As with its predecessors, cyclamates and saccharin, questions have arisen about aspartame’s safety. (Aspartame as a tabletop sweetener is called Equal, and in food products it is called NutraSweet.) Unlike cyclamates and saccharin, which are both completely non-caloric, aspartame has four calories per gram, the same as sugar. But because aspartame is 180 times sweeter than sugar, the amount used in

Self-monitoring of blood glucose: an essential tool for the RD/CDE.

Correspondence to Sue Thom, RD, LD, CDE, Partner and Clinical Specialist, P.O. Box 5092, Cleveland, OH 44101-0092. This article presents two key objectives : 1) to promote self-monitoring of blood glucose (SMBG) as a tool to provide varied meal planning approaches for the person with diabetes and to improve meal planning skills for the Registered Dietitian RD, and 2) to illustrate that improved glycemic control is contingent upon improved meal planning skills and increased dietary options. Thus, SMBG serves as a means to the

Book Reviews : Family Cookbook Volume II. The American Diabetes Association, The American Dietetic Association, Englewood Cliffs, New Jersey, Prentice-Hall, Inc., 1984, 448 pages, (hardcover)

dedication being apparent to the field of diabetes. Although written for physicians, any health educator would gain enormously from the contents. Not only are the why’s emphasized on blood glucose selfmonitoring, but the how-to’s are included, making the book a tool for the busy practice. To illustrate how helpful self-monitoring is, case studies are cited which make the practical applications, once again, very apparent. Patient forms and a sample form for reimbursement are included. The book

15.95:

Editor: Karmeen Kulkarni, RD, MS High Fiber Diets: How and Why Contributor: Cynthia Chandler, MS, RD Lexington, Kentucky The schools of thought on nutrition guidelines for diabetes control are as varied and complex today as they have historically been. The nutrition practitioner is presented with an array of programs to choose from, each having its own strengths and weaknesses. Until the time (if ever) when there is a hard and fast answer to the &dquo;Best Diet&dquo; for diabetes control, the health professional must make a decision as to what is appropriate for the patient. High fiber diets are one method of choice for use in diabetes