Individual counseling in changing dietary habits in diabetics

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Individual counseling in changing dietary habits
in diabetics

• Maruša Pavcic,
• Andrej Janež,
• Zdenka Novak
• Diabetes Association Ljubljana, Slovenija

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Goals of Medical Nutrition Therapy in Diabetics

• normalization of blood sugar,
• prevention or improvement in the other
  diet-related diseases associated with Diabetes
  Mellitus and
• prevention or improvement in the long-term
  complications.

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Compliance to Nutrition Recommendations in
Diabetics

• Very low
• Could be facilitated by
• diabetes self-management education
• evidence-based nutritional counselling
• recommendations adapted to individual nutritional
  needs and dietary patterns

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Educational workshops

• Organizer Diabetes Association Ljubljana
• Organized for 4 local associations (Ljubljana,
  Zagorje, Trbovlje, Litija)
• Participants 292 patients (85 ?, 197?), 92 of
  them gt 1 year after the workshop
• FundingLjubljana municipality, FIHO - Foundation
  for financing the disability and humanitarian
  organisations in the Republic of Slovenia,
  patients participations

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Initial patients profile
¹ADA Standards of Medical Care for Patients with
Diabetes Mellitus, Diabetes Care v. 25S, 2002 ²
Physical activity index 0 not physical active, 1
walking, cycling 1hour daily or less, 2 walking,
cycling more than 1hour daily, 3 active
sport activity
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Initial patients profile 2
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Contents of educational workshops

• Small groups (up to 10 diabetics), same treatment
  
• 7 meetings (5x with diabetologist, 1x dietitian,
  1x nurse podologist)
• Preventive foots check-up
• Questionnaire about dietary habits
• Written individual recommendation for improving
  dietary habits
• Evidence based discussions about metabolic
  control, lipids control, control of blood
  pressure, suitable nutrition, and foot care for
  prevention of complications

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Questionaire about dietary habits and physical
activity

• Number and timing of meals and out of meals food
• Who prepares and purchases food
• Frequency of typical foods markers for the main
  nutritional recommendations (low fat foods, fish,
  high vegetable and fruit, high fibre, low GI
  foods)
• Frequency of typical drinks
• 2 daily menus (in day of questionnaire completion
  and 1 day before)
• Physical activity (intensity and duration)

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Profiles

• Start of workshopweight, BMI, WHR, HbA1C,
  cholesterol (total), blood pressure
• End of workshopHbA1C
• gt 1 year later weight, BMI, WHR, HbA1C,
  cholesterol (total), blood pressure, questionaire
  about dietary changes

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Initial nutritional profile
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Initial frequency of consuming some foods per week
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Improvement in metabolic control normal weight
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Improvement in metabolic control overweight
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Improvement in metabolic control obese
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The main dietary changes after 1 year
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Next step short thematic workshops

• Adapting therapy to phisical activity
• Chronic complications of Diabetes Mellitus
• Hypoglycemia
• Pregnancy and diabetes
• Depression and diabetes
• Slimming for diabetics

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Conclusions

• Educational workshop is suitable method for
  improvement and empowerment knowledge of
  patients
• Individual nutritional counselling as part of
  self-management education can improve compliance
  to nutrition recommendations and diabetes
  management
• Participation on workshops improved diabetes
  management in overweight and obese patients, but
  not in patients with normal weight
• Further thematic workshops for healty slimming is
  needed for owerweight and obese patients

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Thank you