Diabetes is becoming increasingly more prevalent in the U.S. and in the state of Vermont. With an increased prevalence of diabetes and a worsening obesity crisis, the total cost of diabetes management is increasing as well. The population around Bellows Falls, VT has not been spared from this epidemic. Many patients in this region have struggled to make and maintain lifestyle changes, particularly surrounding diet and exercise. Therefore, a one-page, double-sided handout was created to provide easily digestible information to patients about managing their diabetes through proper nutrition.https://scholarworks.uvm.edu/fmclerk/1515/thumbnail.jp

Watkins, Caleb Lee

English

UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2019A Quick Guide To Eating Healthy with Type IIDiabetesCaleb Lee WatkinsFollow 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 CitationWatkins, Caleb Lee, "A Quick Guide To Eating Healthy with Type II Diabetes" (2019). Family Medicine Clerkship Student Projects. 450.https://scholarworks.uvm.edu/fmclerk/450A Quick Guide To Eating Healthy with Type II Diabetes1By Caleb WatkinsFamily Medicine Clerkship: March 2019Location: Rockingham Health Center, Bellows Falls, VTProject Mentor: Dr. Robert SchwartzProblem Identification• Quickly after beginning my clerkship at the Rockingham Health Center with Dr. Schwartz, I noticed that one of the most common reasons for having an appointment was “diabetes follow-up.”• Many of these patients struggled with managing necessary lifestyle modifications, particularly around nutrition.• Therefore, I focused my project on educating patients about how to eat healthy with diabetes.2Public Health Cost of Diabetes in the U.S.• The public health cost of diabetes has been rising steadily over the past few years.• In 2012, the cost was estimated to be $245 billion.• In 2017, this increased to $327 billion (26% over 5 years)• The majority of these costs come from inpatient care, prescription medications to treat complications of diabetes, and prescription medications to treat diabetes.• Many of these costs could be significantly reduced with lifestyle and diet modifications alone.3(American Diabetes Association, 2019)Public Health Cost of Diabetes in Vermont• 10% (55,780) of the adult population in Vermont suffers from diabetes.• 3% (16,000) of the population likely have diabetes but are unaware.• An additional 35.7% (174,000) of Vermonters have prediabetes.• Direct medical expenses for all types of diabetes in Vermont was $360 million in 2017 with up to an additional $160 million lost due to decreased productivity related to diabetes.4(American Diabetes Association, 2018)Community perspectives• Interview  1: Jill McKenny, R.D., Community Health Team, Springfield Medical Care Systems, VT• McKenny agreed that type II diabetes was a major issue in this region.• McKenny provided useful information about managing diabetes with lifestyle modifications.• We also discussed common misconceptions that patients with diabetes have regarding nutrition, including:• “All fruits are off limits”• “All breads are off limits,” and• “Sugar free items are healthy”5Community perspectives• Interview  2: Dr. Robert Schwartz, M.D., Rockingham Health Center, Bellows Falls, VT• Dr. Schwartz and I discussed the care of patients with diabetes and pre-diabetes regularly.• Many of his patients with newly diagnosed diabetes or pre-diabetes initially struggle with dietary and lifestyle modifications.• Dr. Schwartz counsels these patients about the importance of proper nutrition and other lifestyle modifications in order to prevent the progression and complications of diabetes.• Many of these patients are able to control, or limit the progression of, their diabetes by making lifestyle changes +/- anti-diabetic medications like metformin.• However, some patients continue to struggle with their nutrition and could use additional counseling and resources.6Intervention & Methodology• I created a one-paged, double-sided handout.• The handout is designed to give patients a brief, easy to digest, overview about eating healthy with diabetes.78Results & Responses• Dr. Schwartz stated that the handout looked professional and included information that is useful to his patients.• The handout is available for printing and distribution to patients at the Rockingham Health Center.9Evaluation of Effectiveness• A formal evaluation of effectiveness has not yet been performed.• Methodology for evaluating the effectiveness of the handout could include a brief follow up survey asking patients how helpful they thought the handout was and if they have made any changes based on the information in the handout.• Additionally, metrics related to diabetes, such as hemoglobin A1c, blood glucose, lipids, & waist circumference, could be collected at a three- or six-month follow-up visits and compared to pre-handout metrics.10Limitations• Patients have not been consulted regarding the perceived usefulness of the handout.• Patients have not been consulted regarding what they would like to see on the handout.• Due to time constraints, the efficacy of the handout has not yet been examined.11Future directions• While the handout may be useful, it is still necessary to examine why the handout is necessary to begin with. Future interventions should focus on identifying additional barriers to making lifestyle modifications in addition to making educational information more easily available to patients.• Future interventions should take patient recommendations into account. Understanding what patients want to know more about in relation to their diabetes will be instrumental in creating useful educational material.• The efficacy of this intervention should be examined.12References1. American Diabetes Association. (2019). The Cost of Diabetes. Retrieved March 7, 2019, from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html.2. American Diabetes Association. (2018). The Burden of Diabetes in Vermont. Retrieved March 7, 2019, from http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/vermont.pdf.3. CDC.gov. (2018). Eat Well!. Retrieved March 1, 2019, from https://www.cdc.gov/diabetes/managing/eat-well.html4. ChooseMyPlate.gov. (n.d.). Retrieved March 1, 2019.5. Diabetes.org. (n.d.). Retrieved March 1, 2019.6. DiabetesEducator.org. (n.d.). Retrieved March 1, 2019.7. NIDDK.NIH.gov. (n.d.). Retrieved March 1, 2019.13Interview Consent FormThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website.  Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X__ / No _____ If not consenting as above: please add the interviewee names here for the department of Family Medicine information only. Name:                                                           _Jill McKenny, R.D.____________________________________________________Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website.  Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X__ / No _____ If not consenting as above: please add the interviewee names here for the department of Family Medicine information only. Name:                                                           _Dr. Robert Schwartz, M.D.______________________________________________14

A Quick Guide To Eating Healthy with Type II Diabetes

Diabetes is becoming increasingly more prevalent in the U.S. and in the state of Vermont. With an increased prevalence of diabetes and a worsening obesity crisis, the total cost of diabetes management is increasing as well. The population around Bellows Falls, VT has not been spared from this epidemic. Many patients in this region have struggled to make and maintain lifestyle changes, particularly surrounding diet and exercise. Therefore, a one-page, double-sided handout was created to provide easily digestible information to patients about managing their diabetes through proper nutrition.https://scholarworks.uvm.edu/fmclerk/1517/thumbnail.jp

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2019A Quick Guide To Eating Healthy with Type IIDiabetesCaleb Lee WatkinsFollow 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 CitationWatkins, Caleb Lee, "A Quick Guide To Eating Healthy with Type II Diabetes" (2019). Family Medicine Clerkship Student Projects. 449.https://scholarworks.uvm.edu/fmclerk/449A Quick Guide To Eating Healthy with Type II Diabetes1By Caleb WatkinsFamily Medicine Clerkship: March 2019Location: Rockingham Health Center, Bellows Falls, VTProject Mentor: Dr. Robert SchwartzProblem Identification• Quickly after beginning my clerkship at the Rockingham Health Center with Dr. Schwartz, I noticed that one of the most common reasons for having an appointment was “diabetes follow-up.”• Many of these patients struggled with managing necessary lifestyle modifications, particularly around nutrition.• Therefore, I focused my project on educating patients about how to eat healthy with diabetes.2Public Health Cost of Diabetes in the U.S.• The public health cost of diabetes has been rising steadily over the past few years.• In 2012, the cost was estimated to be $245 billion.• In 2017, this increased to $327 billion (26% over 5 years)• The majority of these costs come from inpatient care, prescription medications to treat complications of diabetes, and prescription medications to treat diabetes.• Many of these costs could be significantly reduced with lifestyle and diet modifications alone.3(American Diabetes Association, 2019)Public Health Cost of Diabetes in Vermont• 10% (55,780) of the adult population in Vermont suffers from diabetes.• 3% (16,000) of the population likely have diabetes but are unaware.• An additional 35.7% (174,000) of Vermonters have prediabetes.• Direct medical expenses for all types of diabetes in Vermont was $360 million in 2017 with up to an additional $160 million lost due to decreased productivity related to diabetes.4(American Diabetes Association, 2018)Community perspectives• Interview  1: Jill McKenny, R.D., Community Health Team, Springfield Medical Care Systems, VT• McKenny agreed that type II diabetes was a major issue in this region.• McKenny provided useful information about managing diabetes with lifestyle modifications.• We also discussed common misconceptions that patients with diabetes have regarding nutrition, including:• “All fruits are off limits”• “All breads are off limits,” and• “Sugar free items are healthy”5Community perspectives• Interview  2: Dr. Robert Schwartz, M.D., Rockingham Health Center, Bellows Falls, VT• Dr. Schwartz and I discussed the care of patients with diabetes and pre-diabetes regularly.• Many of his patients with newly diagnosed diabetes or pre-diabetes initially struggle with dietary and lifestyle modifications.• Dr. Schwartz counsels these patients about the importance of proper nutrition and other lifestyle modifications in order to prevent the progression and complications of diabetes.• Many of these patients are able to control, or limit the progression of, their diabetes by making lifestyle changes +/- anti-diabetic medications like metformin.• However, some patients continue to struggle with their nutrition and could use additional counseling and resources.6Intervention & Methodology• I created a one-paged, double-sided handout.• The handout is designed to give patients a brief, easy to digest, overview about eating healthy with diabetes.78Results & Responses• Dr. Schwartz stated that the handout looked professional and included information that is useful to his patients.• The handout is available for printing and distribution to patients at the Rockingham Health Center.9Evaluation of Effectiveness• A formal evaluation of effectiveness has not yet been performed.• Methodology for evaluating the effectiveness of the handout could include a brief follow up survey asking patients how helpful they thought the handout was and if they have made any changes based on the information in the handout.• Additionally, metrics related to diabetes, such as hemoglobin A1c, blood glucose, lipids, & waist circumference, could be collected at a three- or six-month follow-up visits and compared to pre-handout metrics.10Limitations• Patients have not been consulted regarding the perceived usefulness of the handout.• Patients have not been consulted regarding what they would like to see on the handout.• Due to time constraints, the efficacy of the handout has not yet been examined.11Future directions• While the handout may be useful, it is still necessary to examine why the handout is necessary to begin with. Future interventions should focus on identifying additional barriers to making lifestyle modifications in addition to making educational information more easily available to patients.• Future interventions should take patient recommendations into account. Understanding what patients want to know more about in relation to their diabetes will be instrumental in creating useful educational material.• The efficacy of this intervention should be examined.12References1. American Diabetes Association. (2019). The Cost of Diabetes. Retrieved March 7, 2019, from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html.2. American Diabetes Association. (2018). The Burden of Diabetes in Vermont. Retrieved March 7, 2019, from http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/vermont.pdf.3. CDC.gov. (2018). Eat Well!. Retrieved March 1, 2019, from https://www.cdc.gov/diabetes/managing/eat-well.html4. ChooseMyPlate.gov. (n.d.). Retrieved March 1, 2019.5. Diabetes.org. (n.d.). Retrieved March 1, 2019.6. DiabetesEducator.org. (n.d.). Retrieved March 1, 2019.7. NIDDK.NIH.gov. (n.d.). Retrieved March 1, 2019.13Interview Consent FormThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website.  Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X__ / No _____ If not consenting as above: please add the interviewee names here for the department of Family Medicine information only. Name:                                                           _Jill McKenny, R.D.____________________________________________________Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website.  Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X__ / No _____ If not consenting as above: please add the interviewee names here for the department of Family Medicine information only. Name:                                                           _Dr. Robert Schwartz, M.D.______________________________________________14

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A Quick Guide To Eating Healthy with Type II Diabetes

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