Kay Craven

Nutrition Strategies for Patients on New Incretin Therapies for Type 2 Diabetes

The number of Americans with type 2 diabetes has grown fromanestimated20.8million in2005 to29.1million in2012 or 9.3%of the population (www.diabetes.org/diabetes-basis/ statistics).Medications for the treatment of type 2 diabetes targeting incretin hormones for improved glycemic control have emerged as favorable second-line additions to metformin and lifestyle changes. In this article, we discuss the benefits of using glucagon-like peptide 1 receptor agonist medications anddipeptidyl peptidase 4 inhibitors alongwith their implications for weight and dietary management of type 2 diabetes. Nutr Today. 2014;49(5):254Y261

Feeding Insulin: Adverse Consequences With Tight Glycemic Control

Approximately 80% of people with type 2 diabetes mellitus are obese and are encouraged to loseweight by increasing physical activity and controlling dietary intake, while maintaining optimal glycemic control. Physical activity and diet, along with medication, will have an impact on an individual’s daily blood glucose fluctuations. Healthcare providers evaluate patient glycemic control by measuring hemoglobin A1c. Providers often work with patients with type 2 diabetes mellitus to achieve a hemoglobin A1c level less than 7% to achieve better overall health outcomes; however, a serious complication of working toward that goalVsometimes referred to as ‘‘tight glycemic control’’V can be hypoglycemia. Hypoglycemia typically is treated by the patient consuming carbohydrate. This strategy can have unintended consequences for patients who are already overweight or obese. In this article, we present a case from our clinic to describe howa patient trying to followher type 2management plan developed a fear of hypoglycemia and adopted behaviors that had unintended consequences. We present evidence-based strategies for treating hypoglycemiawith a carbohydrate food or beverage. Nutr Today. 2015;50(3):109Y116

Validation of a combined health literacy and numeracy instrument for patients with type 2 diabetes

OBJECTIVES This study aimed to validate a new consolidated measure of health literacy and numeracy (health literacy scale [HLS] plus the subjective numeracy scale [SNS]) in patients with type 2 diabetes (T2DM). METHODS A convenience sample (N = 102) of patients with T2DM was recruited from an academic family medicine center in the southeastern US between September-December 2017. Participants completed a questionnaire that included the composite HLS/SNS (22 questions) and a commonly used objective measure of health literacy-S-TOFHLA (40 questions). Internal reliability of the HLS/SNS was assessed using Cronbachs alpha. Criterion and construct validity was assessed against the S-TOFHLA. RESULTS The composite HLS/SNS had good internal reliability (Cronbachs alpha = 0.83). A confirmatory factor analysis revealed there were four factors in the new instrument. Model fit indices showed good model-data fit (RMSEA = 0.08). The Spearmans rank order correlation coefficient between the HLS/SNS and the S-TOFHLA was 0.45 (p < 0.01). CONCLUSIONS Our study suggests that the composite HLS/SNS is a reliable, valid instrument.

Food Insecurity: It Is More Common Than You Think, Recognizing It Can Improve the Care You Give

In this article, we present a case from our Interprofessional Diabetes Clinic to describe assessment and impact of food insecurity on a patient’s overall health and how the healthcare providers’ recognition of food insecurity changed the management of a patient with type 2 diabetes mellitus, obesity, and depression. This approach to treating patients with food insecurity may also apply to individuals with diabetes who regularly skipmeals; are inconsistent with their carbohydrate intake, for whatever reason; or routinely engage in fasting. Healthcare professionals should screen all patients for food insecurity, educate patients to use appropriate coping strategies, adjust medications to minimize adverse effects, recognize that food insecurity is cyclical for most, connect patients with community resources, and advocate for services in clinics and hospitals. Nutr Today. 2017;52(5):248Y257

Nutrition for Athletic Youth With Weight Concerns Chron's Disease and Disordered Eating Cases

More than 35 million youth, aged 5 to 18 years old, in the United States play organized sports. Surprisingly, data to guide nutritional recommendations for child and adolescent athletes are not readily available. Some of these youth not only have the nutrient needs for appropriate growth and development but also to manage their weight and/or a chronic disease. In this article, 2 cases from a Family Medicine Nutrition clinic are presented to highlight nutrition issues faced by these youth. Nutr Today. 2014;49(2):57Y67