One of the most effective ways to assist patients with diabetes is to empower them to manage their diabetes through lifestyle change. However, figuring out what to eat when you have diabetes can be very confusing. This project attempted to provide simple lifestyle changes patients could make.https://scholarworks.uvm.edu/fmclerk/1328/thumbnail.jp

Dalton, Kristen M

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2017Nutrition, Diabetes and MisconceptionsKristen M. DaltonUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationDalton, Kristen M., "Nutrition, Diabetes and Misconceptions" (2017). Family Medicine Clerkship Student Projects. 290.https://scholarworks.uvm.edu/fmclerk/290Nutrition, Diabetes and MisconceptionsKristen Dalton, MS3Hinesburg Family HealthFamily Medicine Rotation #36/26/2017 – 8/11/2017Problem Identification: Diabetes &Poor Nutritional Literacy• Diabetes is a disease in which the body cannot make or utilize insulin appropriately.• This results in elevated blood sugar levels which can cause damage to many tissues and organs. • As of  2016, diabetes affects 29.1 million people in the United States.1• And it affects 50,000 people in Vermont.2• It is estimated that 1/3 of  Americans could develop diabetes by the year 2050.1• Research has shown us that weight loss is key to managing type 2 diabetes3 and that caloric restriction is more important than physical activity when it comes to weight loss.4• Fruits and vegetables are low in calories but most people are not eating enough.• As of  2016, 75% of  adult Vermonters do not eat the recommended 5 fruits and vegetables per day.5• These trends might be related to poor nutritional literacy• 8 out of  10 consumers say they encounter “a lot of  conflicting information about what to eat.”6• 56 percent of  consumers say the “conflicting information makes them doubt the choices they make.”6Public Health CostsNational Costs:• Diabetes increases all-cause mortality rate by 1.8.• It is the leading cause of  kidney failure, lower limb amputations, and adult-onset blindness.• $245 billion is the total cost of  diabetes in the U.S.• Including costs of medical care, disability, and premature death.1Vermont Costs:• In 2012, the costs of  total direct medical expenses in Vermont was $409 million.• This includes diabetes, prediabetes, gestational diabetes both diagnosed and undiagnosed.7• In addition to direct medical costs, it was estimated during 2012 in Vermont that an additional $134 million was spent on indirect costs.• These indirect costs include work absenteeism and lost productivity while working due to physical impairment.7Research has shown us ways to save money:• The Look AHEAD trial is a national clinical trial that has studied the effects of  an intensive lifestyle intervention compared to a control group in a population of  patients with type 2 diabetes, BMI>25, between the ages of  45-75. • Demonstrated fewer anti-hypertensive and lipid-lowering medications8, hospitalizations, less days in hospital and overall prescription usage in the ILI group.9• The cost analysis for the study demonstrated that even with the costs of the intervention, participants could save $600 over 10 years.9• The IDOLc study, which was a Look AHEAD translation study, determined that participants in the 6 month lifestyle program lost more weight, had greater A1C reductions, and were on less medications.• The costs of the programs, after including savings from medication reduction, were comparable: $162 for dietitian counseling and $192 for lifestyle groups.10Community Perspective (A)• Linda Tilton, RD, CDE at UVMMC, has been counseling patients on their diabetes for many years. She stresses the importance of  the patient understanding what their diagnosis means as well as acknowledging the emotions that come along with the diagnosis. She concedes that people will come to her without truly understanding what having diabetes means.• “It is critical, when someone receives a diagnosis, that they meet with someone who has the time to sit and listen to their concerns and frame their diagnosis in a positive way.” This allows the patient to release themselves from their “burden of  guilt” and “come up with goals that are achievable.”• Linda Tilton states that an initial visit with her is usually focused on the diagnosis and breaking down the pathophysiology of  the disease so the patient understands “why good control matters” because too often this is confusing to patients.• After this has been established, she delves into lifestyle changes stating that “lifestyle is the foundation” of  diabetes management. Carbohydrates seem to come up frequently and Linda Tilton tell her patients that “carbs can be healthy or not. The key is moderation.”Community Perspective (B)• Emily Clairmont, RD is a member of  the Community Health Team at UVMMC, acknowledges that the current messages surrounding nutrition can be confusing and often lead patients to wonder “what can I eat?” This feeling, in addition to a possible new diagnosis of  diabetes, can lead many patients feeling discouraged. This is why she stresses balance.• “It is fine to have carbohydrates to an extent. If  you have a carbohydrate, you need to have protein! Carbohydrates still turn into sugar but it will do so a lot slower with a protein on board.”• Emily Clairmont states that with all of  the nutritional information she is giving out during her sessions she tries to make it positive. “I try and tell them more of  what they can do instead of  what they cannot.”Intervention and Methods• Intervention – patient education• A one-page document was created to clarify common misconceptions that people have regarding appropriate lifestyle changes that can be made to improve their health.• The common misconceptions were gathered by community interviews with Emily Clairmont, RD, and Linda Tilton, CDE, RD.• How to deliver this new tool:• After Visit Summary (AVS) Smart Phrase entry• Providers will be able to write the smart phrase text into the AVS and the information will automatically enter there.• Handouts• Handouts were made available in the waiting room of  Hinesburg Family Health.Effectiveness and Limitations• Effectiveness• In order to measure how effective this information was, we can gather patient satisfaction data.• We can also compare patients’ weights and A1Cs from their last provider visit to their first visit with a CDE or RD, before the handouts were available and after, to see if  patients were able to implement changes and decrease their weights and/or A1Cs .• Limitations• Lifestyle change takes time and practice before improvements can be seen.• In order to see the effectiveness of  a lifestyle change, progress must be followed for a long period of  time, which we could not do.• Every patient has different changes that they need to make and the information we have provided may not be useful for all patients.Recommendations for future• Make the handout, smart phrase more specific.• Could have one for soda-drinkers, one for people who eat too little protein, etc.• Collect data asking patients what they are confused about.• Use this information to make necessary changes to the handout, smart phrase.• Information could be mailed to patients that haven’t come into the clinic but were either diagnosed with diabetes or prediabetes at their last visit.• This information could be given to people with prediabetes.References• 1. “Diabetes.” Healthy People 2020, Office of Disease Prevention and Health Promotion, www.healthypeople.gov/2020/topics-objectives/topic/diabetes#4.• 2. “QuickFacts.” U.S. Census Bureau QuickFacts Selected: Vermont, U.S. Department of Commerce, www.census.gov/quickfacts/fact/table/VT/PST045216.• 3. Clinical practice recommendations. Alexandria, VA: American Diabetes Association, 2013• 4. Redman, L.M., Heilbronn, L.K., Martin, C.K., Alfonso, A., Smith, S.R., Ravussin E. for Pennington CALERIE Team. Effect of Calorie Restriction with or without Exercise on Body Composition and Fat Distribution. J Clin Endocrinol Metab. 2007 March; 92(3): 865-872.• 5. “3-4-50 Scorecard.” Vermont Department of Health, State of Vermont, 23 Dec. 2016, www.healthvermont.gov/scorecard-3-4-50.• 6. “Survey: Nutrition Information Abounds, But Many Doubt Food Choices.” FoodInsight.org, International Food Information Council Foundation, 5 May 2017, www.foodinsight.org/press-releases/survey-nutrition-information-abounds-many-doubt-food-choices.• 7. American Diabetes Association. The Burden of Diabetes in Vermont. [PDF file]. Retrieved from http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/vermont.pdf• 8. The Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four year results of Look AHEAD trial. Arch Intern Med. 2010; 170: 1566-1575• 9. Espeland MA, Glick HA, Bertoni A, et al. Look AHEAD Research Group. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: The Action for Health in Diabetes. Diabetes Care. 2014; 37: 2548–2556.• 10. Delahanty, Linda M, et al. “Obesity.” Improving Diabetes Outcomes Through Lifestyle Change - A Randomized Controlled Trial. 2015 September; 23(9): 1792–1799.

Nutrition, Diabetes and Misconceptions

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