Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes. The Diabetes Care and Education Dietetic Practice Group

OBJECTIVES

Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life.

DESIGN

Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life.

SUBJECTS/SETTINGS

Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods.

STATISTICAL ANALYSIS

chi 2 Test, t test, and analysis of covariance.

RESULTS

Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful.

CONCLUSIONS/APPLICATIONS

Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care of perceived quality of life.

Mixtures of Ascorbyl-stearate and Vitamin D3: A Monolayer Study at the Gas/Water Interface

Vitamin C and vitamin D3 perform different and important activities in living systems. Vitamin D3 forms stable monomolecular films at the gas/water interface and, at higher concentrations, produces large aggregates in water solutions. Because of their amphiphilic structure, vitamin C alkyl esters form monolayers, micelles, vesicles, or microemulsions in water, depending on composition, concentration, solvent, and temperature. In this work the monolayer of 6-O-ascorbyl-stearate and vitamin D3 was studied to investigate the behavior of the two compounds and their mixtures at the gas/water interface at different temperatures, at different pH, and in the presence of Ca2+ in the subphase. The results show that stable Langmuir films are formed in all molar ratios, with repulsive interactions between the two components, and that the presence of calcium ions modifies the properties of the monolayer.

Controlled-release tablet formulation of isoniazid

Guar (GG) and Karaya gums (KG) alone and in combination with hydroxy-propylmethylcellulose (HPMC) were evaluated as release retarding materials to formulate a controlled-release tablet dosage form of isoniazid (1). In vitro release of 1 from tablets followed non-Fickian release profile with rapid initial release. Urinary excretion studies in normal subjects showed steady-state levels of 1 for 13 h. In vitro and in vivo data correlated (r = 0.9794). The studies suggested the potentiality of GG and KG as release retarding materials in formulating controlled-release tablet dosage forms of 1.

Incidence of Gardnerella vaginalis infection in pregnant & non-pregnant women with non-specific vaginitis

The occurrence of G. vaginalis in patients with non-specific vaginitis (NSV) was studied. Of the 200 women with vaginitis screened, 84 were diagnosed to have non-specific vaginitis. G. vaginalis was isolated from 33 (39.28%) patients either alone or in combination with other organisms, while one of the healthy controls with no vaginal discharge yielded G. vaginalis on culture. The nature of vaginal discharge could not be correlated with the type of infection. Clue cells and amine test gave inconsistent results in the presence of G. vaginalis infection. A varying susceptibility pattern of G. vaginalis was observed against various antimicrobials, metronidazole (95%) and gentamicin (75%) showing highest sensitivity.