The Science of Diabetes Self-Management and Care

This paper provides an historical documentation and discussion of events that have influenced diabetes nutritional management in recent years. Many factors have shaped the nutrition care that persons with diabetes receive today. Nutrition science research is part of the history, as are myriad discoveries, research, advanced technologies, and evolving health care systems. This review of the past four decades will contribute a perspective of how we have gotten to where we are today.

A study was conducted to investigate both the perceived and actual knowledge of diet by 101 individuals with non-insulin- dependent diabetes mellitus (NIDDM). A survey instrument was developed containing three sections: perceptions of diet knowledge, demonstrated knowledge of diet, and demographic information. Perceived and actual knowledge of diet in the study group were compared with the following variables: years of education, types of diabetes regimen, particpation in care, recency of dietary instruction, understanding of diet, and levels of self blood glucose monitoring (SBGM). Analysis indicated significant differences for knowledge and levels of education, perceptions and knowledge and recency of instruction, perceptions and knowledge and understanding of diet, and perceptions and self blood glucose monitoring. A positive linear relationship was noted between perceptions and actual knowledge of the diabetic diet.

A primary goal of treatment in obese individuals with NIDDM is weight loss and maintenance. Obesity is a precipitating factor for the development of NIDDM in individuals who are genetically at risk. A variety of weight-loss regimens are available to match the specific needs and lifestyles of individuals. Hypocaloric high-fiber diets have been found to be effective in achieving weight loss, as well as aiding in glycemic and lipid control. very low calorie diets, administered under medical supervision, are useful for obese NIDDM patients with 18-55 kilograms of weight to lose. Lifestyle education appears to be an important element of any successful weight loss program.

The Diabetes Quality Assurance (DQA) Checklist was developed to measure adherence to standards of diabetes care. Two raters simultaneously scored a convenience sample of 23 charts of patients with diabetes. These raters scored each chart again 5-7 weeks later. Data obtained were used to assess inter-rater and intra-rater reliability. Inter-rater reliability was estimated for basic assessment at Time 1 (r = 0.94, 95% CI 0.86-0.97) and at Time 2 (r = 0. 91, 95% CI 0.81-0.96); and for high-risk assessment at Time 1 (r = 0.88, 95% CI 0.73-0.95). Intra-rater reliability for the basic assessment was estimated for Reviewer 1 (r = 0.84, 95% CI 0.65-0.93) and for Reviewer 2 (r = 0.75, 95% CI 0.49-0.89); the high-risk estimate for Review I was 0.60 (95% CI 0.25-0.81) and for Reviewer 2 0.97 (95% CI 0.94-0.99). The DQA Checklist is useful for monitoring and assessing diabetes care.

The effect of a nutrition education program on knowledge and self-care behavior in a group of individuals with diabetes was evaluated. The nutrition education program was developed using outlines and knowledge tests produced by the Universiy of Michigan Diabetes Research and Training Center. The program, sponsored by the American Diabetes Association, Akron Chapter, was presented free of charge to Northeast Ohio area residents. Forty-four individuals participated in the study. Results indicated a statistically significant (p<0.01) gain in knowledge but no statistically significant change in eating behavior for the sample. However, post-food records indicated that the mean for the percentage of total kcalories (kcals) from protein and fat (ie, 20% and 28%, respectively) were within the American Diabetes Association's recommendations of no more than 20% of kcals from protein and 30% of kcals from fat. In addition, the percentage of kcals from carbohydrate and the recommended total number of kcals improved toward the recommended levels.

Most patients with diabetes generally do not require routine vitamin and mineral supplementation, just like the rest of the population. However, based on the published medical literature, it would appear that some degree of supplementation with certain vitamins (eg, vitamins C and E) and minerals (eg, magnesium) may be worthwhile and become more commonly recommended in the future. The role of vitamins and minerals in controlling blood glucose levels in the patients with diabetes also is discussed.