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Houle J, Beaulieu MD, Chiasson JL, Lespérance F, Côté J, Strychar I, Bherer L, Meunier S, Lambert J. Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study. Diabet Med 2015; 32:1247-54. [PMID: 25581545 DOI: 10.1111/dme.12686] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 10/21/2014] [Accepted: 01/06/2015] [Indexed: 12/17/2022]
Abstract
AIM To better understand the associations between changes in self-management behaviours and glycaemic control. METHODS We conducted a prospective observational study of 295 adult patients with Type 2 diabetes evaluated at baseline, 6 and 12 months. Four self-management behaviours were evaluated using the Summary of Diabetes Self-Care Activities instrument, which assesses healthy diet, physical activity, medication taking and self-monitoring of blood glucose. Using hierarchical linear regression models, we tested whether changes in self-management behaviours were associated with short-term (6-month) or long-term (12-month) changes in glycaemic control, after controlling for demographic and clinical characteristics. RESULTS Improved diet was associated with a decrease in HbA1c level, both at 6 and 12 months. Improved medication taking was associated with short-term improvement in glycaemic control, while increased self-monitoring of blood glucose frequency was associated with a 12-month improvement in HbA1c . Completely stopping exercise after being physically active at baseline was associated with a rise in HbA1c level at 6-month follow-up. Interaction analysis indicated that a healthy diet benefitted all participant subgroups, but that medication taking was associated with glycaemic control only for participants living in poverty and more strongly for those with lower educational levels. Finally, a higher self-monitoring of blood glucose frequency was associated with better glycaemic control only in insulin-treated participants. CONCLUSIONS Even after adjusting for potential confounders (including baseline HbA1c ), increased frequency of healthy diet, medication taking and self-monitoring of blood glucose were associated with improved HbA1c levels. These self-management behaviours should be regularly monitored to identify patients at risk of deterioration in glycaemic control. Barriers to optimum self-management should be removed, particularly among socio-economically disadvantaged populations.
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Affiliation(s)
- J Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
| | - M-D Beaulieu
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - J-L Chiasson
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - F Lespérance
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Quebec, Canada
| | - J Côté
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - I Strychar
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Quebec, Canada
| | - L Bherer
- PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Institut de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - S Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - J Lambert
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
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Leroux C, Gingras V, Desjardins K, Brazeau AS, Ott-Braschi S, Strychar I, Rabasa-Lhoret R. In adult patients with type 1 diabetes healthy lifestyle associates with a better cardiometabolic profile. Nutr Metab Cardiovasc Dis 2015; 25:444-451. [PMID: 25770760 DOI: 10.1016/j.numecd.2015.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Little is known about lifestyle habits of adults with type 1 diabetes (T1D) and their association with cardiometabolic risk (CMR) factors. The aims of the present study were to determine the prevalence of adults with T1D who adopted a healthy lifestyle and to explore the association between a healthy lifestyle and the cardiometabolic profile. METHODS AND RESULTS This is a cross-sectional analysis of 115 adults with T1D. Participants wore a motion sensor and completed a 3-day food record. The following CMR factors were assessed: body mass index, waist circumference, body composition (iDXA), glycated hemoglobin, lipids and blood pressure. Insulin resistance was estimated (estimated glucose disposal rate). Participants were classified according to the number of healthy lifestyle habits adopted (ranging from 0 to 3): regular physical activity (physical activity level ≥1.7), good diet quality (Canadian Healthy Eating Index score >80) and none-smoking status. The proportion of participants who adopted 3, 2, 1 or 0 lifestyle habits were 11%, 30%, 37%, and 23%, respectively. As the number of healthy lifestyle habits adopted increased, participants had significantly lower body mass index, waist circumference, body fat, total cholesterol, non-HDL-cholesterol, triglycerides and systolic blood pressure (p < 0.05). In addition, a trend for lower estimated insulin resistance was observed (p = 0.06). For each increase of one healthy lifestyle habit, body mass index decreased by 1.9 kg/m(2), waist circumference by 4.0 cm for men and 4.8 cm for women and trunk fat by 3.6% for men and 4.1% for women. CONCLUSIONS These results suggest the importance of a healthy lifestyle among adults with T1D in order to control CMR factors.
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Affiliation(s)
- C Leroux
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - V Gingras
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - K Desjardins
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - A-S Brazeau
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada
| | - S Ott-Braschi
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Division of Endocrinology, Department of Medicine of the Université de Montréal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - I Strychar
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada; Montreal Diabetes Research Center (MDRC), Montreal, Quebec, Canada
| | - R Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal (IRCM), Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada; Montreal Diabetes Research Center (MDRC), Montreal, Quebec, Canada; Division of Endocrinology, Department of Medicine of the Université de Montréal Hospital Center (CHUM), Montreal, Quebec, Canada.
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Desjardins K, Brazeau AS, Strychar I, Rabasa-Lhoret R. Are bedtime nutritional strategies effective in preventing nocturnal hypoglycaemia in patients with type 1 diabetes? Diabetes Obes Metab 2014; 16:577-87. [PMID: 24320159 DOI: 10.1111/dom.12232] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/04/2013] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Abstract
Hypoglycaemia remains the major limiting factor for adequate diabetes control for patients with type 1 diabetes (T1D), especially during the night-time. Although nutritional strategies for nocturnal hypoglycaemia (NH) prevention are regularly suggested in clinical practice, there is no evidence-based recommendation for the usefulness and optimal composition of a bedtime snack. The aim of this narrative review was to analyse the current state of knowledge on nutritional strategies to prevent NH in individuals with T1D. A literature search was conducted, using PubMed and Medline (1946 to 2013); 16 studies were retrieved. Overall, the level of evidence was low. Results indicated that a calibrated bedtime snack based on bedtime blood glucose (BG) level could be effective to reduce NH occurrence for patients treated with human or animal insulin (short-acting combined with lente, ultralente and/or intermediate-acting insulin), but there is no evidence for patients treated with insulin analogues as part of multiple daily injections or insulin pump regimen. Some evidence suggests that including uncooked cornstarch or alanine in the bedtime snack composition could provide some benefits for the prevention of NH. Individualized recommendations of a bedtime snack intake for patients or situations at high risk for NH (long standing diabetes, hypoglycaemia unawareness, prior physical activity, alcohol consumption, bedtime BG close to hypoglycaemia threshold) appear as a prudent recommendation. On the basis of the available evidence, a bedtime snack cannot be recommended systematically but it might be useful if prescribed in an individualized fashion; further research is needed to evaluate these strategies.
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Affiliation(s)
- K Desjardins
- Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada; Department of nutrition, Université de Montréal, Montreal, Quebec, Canada
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Brazeau AS, Suppere C, Strychar I, Belisle V, Demers SP, Rabasa-Lhoret R. Accuracy of Energy Expenditure Estimation by Activity Monitors Differs with Ethnicity. Int J Sports Med 2014; 35:847-50. [DOI: 10.1055/s-0034-1371837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A.-S. Brazeau
- Plateforme PROMD, Institut de recherches cliniques de Montreal, Montreal, Canada
| | - C. Suppere
- Plateforme PROMD, Institut de recherches cliniques de Montreal, Montreal, Canada
| | - I. Strychar
- Nutrition, Universite de Montreal, Montreal, Canada
| | - V. Belisle
- Plateforme PROMD, Institut de recherches cliniques de Montreal, Montreal, Canada
| | - S.-P. Demers
- Plateforme PROMD, Institut de recherches cliniques de Montreal, Montreal, Canada
| | - R. Rabasa-Lhoret
- Plateforme PROMD, Institut de recherches cliniques de Montreal, Montreal, Canada
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McNeil J, Prud'homme D, Strychar I, Rabasa-Lhoret R, Brochu M, Lavoie JM, Doucet É. Satiety quotient linked to food intake and changes in anthropometry during menopause: a MONET Study. Climacteric 2014; 17:449-55. [DOI: 10.3109/13697137.2014.895320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smith KJ, Rabasa-Lhoret R, Strychar I, Karelis AD, Clyde M, Levasseur J, Pinaroc C, Pedneault M, Schmitz N. Good vs. poor self-rated diabetes control: differences in cardiovascular risk and self-care activities. Exp Clin Endocrinol Diabetes 2014; 122:236-9. [PMID: 24623501 DOI: 10.1055/s-0034-1367005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to assess differences in cardiovascular risk and performance of self-care activities in people who rated their diabetes control as good or poor. METHODS A sub-sample of 77 participants who took part in the Evaluation of Diabetes Treatment telephone interview were invited into a clinic to complete a series of laboratory examinations. Self-rated diabetes control was validated using the following laboratory markers: HbA1c, total cholesterol/HDL cholesterol ratio and LDL cholesterol. Differences in blood pressure and BMI were also assessed. Finally, all participants also completed the Summary of Self-Care activities questionnaire. RESULTS Those people who rated their diabetes control as fair or poor had a significantly higher BMI, HbA1c levels, total cholesterol/HDL-cholesterol ratio and systolic blood pressure. When asked about self-care activities in the past week, those people who reported their diabetes control was fair/poor had spent significantly fewer days following a general diet and exercising. CONCLUSIONS People with poor self-rated diabetes control have unfavourable cardiovascular risk and decreased performance of self-care activities.
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Affiliation(s)
- K J Smith
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - R Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - I Strychar
- Montreal Diabetes Research Center, Montreal, Quebec, Canada
| | - A D Karelis
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - M Clyde
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - J Levasseur
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - C Pinaroc
- Institut de Recherches Cliniques de Montréal, Montréal, Québec, Canada
| | - M Pedneault
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - N Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Duval K, Prud'homme D, Rabasa-Lhoret R, Strychar I, Brochu M, Lavoie JM, Doucet E. Effects of the menopausal transition on energy expenditure: a MONET Group Study. Eur J Clin Nutr 2013; 67:407-11. [PMID: 23422924 PMCID: PMC4977179 DOI: 10.1038/ejcn.2013.33] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives Factors that influence weight gain during the menopausal transition are not fully understood. The purpose of this study was to investigate changes in energy expenditure (EE) across the menopausal transition. Methods One hundred and two premenopausal women (age: 49.9 ± 1.9 yrs; BMI: 23.3 ± 2.2 kg/m2) were followed for 5 years. Body composition (DXA), physical activity EE (accelerometer), resting EE and thermic effect of food (indirect calorimetry) were measured annually. Results Total EE decreased significantly over time in postmenopausal women (P < 0.05), which was mostly due to a decrease in physical activity EE (P < 0.05). Although average resting EE remained stable over time in postmenopausal women, a significant increase, over the 5-year period, was noted in women who were in the menopausal transition by year 5 (P < 0.05). Finally, the time spent in moderate physical activity decreased and the time spent in sedentary physical activity increased during the menopausal transition (P < 0.05). Conclusion These results suggest that menopausal transition is accompanied with a decline in EE mainly characterized by a decrease in physical activity EE and a shift to a more sedentary lifestyle.
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Affiliation(s)
- K Duval
- Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Brazeau AS, Mircescu H, Desjardins K, Leroux C, Strychar I, Ekoé JM, Rabasa-Lhoret R. Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes. Diabetes Res Clin Pract 2013; 99:19-23. [PMID: 23146371 DOI: 10.1016/j.diabres.2012.10.024] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/09/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
AIMS Carbohydrate counting is an established approach used by patients with type 1 diabetes to improve their glycemic control. The aims of this study were to evaluate, in real life conditions, the accuracy of meal carbohydrate estimate and its impact on glycemic variability. METHODS In this cross-sectional study, we observed the ability of 50 adults (48% women) with type 1 diabetes (age: 42.7±11.1 years); diabetes duration: 21.4±12.7 years; HbA1c: 7.2±1.2% (60±10 mmol/mol) to accurately estimate carbohydrates by analyzing 72-h food records and their corresponding 72-h blood glucose excursions using a continuous glucose monitor. RESULTS The mean meal carbohydrate difference, between the patients' estimates and those assessed by a dietitian using a computerized analysis program, was 15.4±7.8 g or 20.9±9.7% of the total CHO content per meal (72.4±34.7 g per meal). Sixty-three percent of the 448 meals analyzed were underestimated. Greater differences in CHO's estimates predicted higher glycemic variability, as measured by the MAGE index and glucose standard deviation, and decreased time with glucose values between 4 and 10 mmol/L (R²=0.110, 0.114 and 0.110, respectively; P<0.05). CONCLUSION Inaccurate carbohydrate counting is frequent and associated with higher daily blood glucose variability in adults with type 1 diabetes.
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Affiliation(s)
- A S Brazeau
- Montreal Institute for Clinical Research (IRCM), Montreal, QC, Canada.
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Abstract
AIMS Despite the detrimental effects of smoking on their health, a high number of adults with Type 2 diabetes continue to smoke. Identifying distinct types of smokers within this population could help tailor and target intervention programmes. This study examined whether smokers with Type 2 diabetes could be classified into different profiles based on smoking habits, socio-economic characteristics and lifestyle factors. METHODS A sample of adults with self-reported diabetes was selected from random-digit dialing. Analyses included 383 participants with Type 2 diabetes who were current smokers. Information related to smoking, socio-economic status, health and lifestyle was collected by phone interview at baseline and 1 year later. Latent class analysis was used to identify subgroups of smokers. RESULTS We uncovered three meaningful classes of smokers: class 1, long-time smokers with long-standing diabetes (n = 105); class 2, heavy smokers with deprived socio-economic status, poor health and unhealthy lifestyle characteristics (n = 105); class 3, working and active smokers who were more recently diagnosed with diabetes (n = 173). Members of class 2 were significantly more likely to be disabled and depressed at baseline and 1 year later compared with other classes. CONCLUSIONS Different profiles of smokers exist among adults with Type 2 diabetes, each suggesting different cessation treatment needs. Distinguishing between these types of smokers may enable clinicians to tailor their approach to smoking cessation.
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Affiliation(s)
- G Gariepy
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
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Gariepy G, Malla A, Wang J, Messier L, Strychar I, Lesage A, Schmitz N. P2-94 Types of smokers, depression and disability in type 2 diabetes: a latent class analysis. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Messier L, Schmitz N, Malla A, Lesage A, Boyer R, Wang J, Strychar I. Lifestyle and self-care behaviours among diabetics with major, minor and no depression: a population based study of adults with diabetes in Quebec. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Karelis AD, Fontaine J, Rabasa-Lhoret R, Prud'homme D, Doucet E, Blanchard C, Garrel D, Strychar I. Psychosocial profile of the metabolically healthy but obese postmenopausal woman. Diabetes Metab 2006; 32:90-1. [PMID: 16523194 DOI: 10.1016/s1262-3636(07)70254-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nadeau J, Koski KG, Strychar I, Yale JF. Teaching subjects with type 2 diabetes how to incorporate sugar choices into their daily meal plan promotes dietary compliance and does not deteriorate metabolic profile. Diabetes Care 2001; 24:222-7. [PMID: 11213869 DOI: 10.2337/diacare.24.2.222] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether teaching free-living subjects with type 2 diabetes how to incorporate added sugars or sweets into their daily meal plan results in a greater consumption of calories (fat or sugar) and deteriorates their glycemic or lipid profiles but improves their perceived quality of life. RESEARCH DESIGN AND METHODS In an 8-month randomized controlled trial, 48 free-living subjects with type 2 diabetes were taught either a conventional (C) meal plan (no concentrated sweets) or one permitting as much as 10% of total energy as added sugars or sweets (S). Mean individual nutrient intake was determined using the average of six 24-h telephone recalls per 4 months. Metabolic control and quality of life were evaluated every 2 months. Quality of life was assessed using the Medical Outcome Survey and the Diabetes Quality of Life questionnaire. RESULTS The S group did not consume more calories (fat or sugar) and in fact ate significantly less carbohydrate (-15 vs. 10 g) and less starch (-7 vs. 8 g) and had a tendency to eat fewer calories (-77 vs. 81 kcal) than the C group. Weight remained stable, and there was no evidence that consuming more sugar worsened metabolic profile or improved their perceived quality of life. CONCLUSIONS Giving individuals with type 2 diabetes the freedom to include sugar in their daily meal plan had no negative impact on dietary habits or metabolic control. Health professionals can be reassured and encouraged to teach the new "sugar guidelines," because doing so may result in a more conscientious carbohydrate consumption.
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Affiliation(s)
- J Nadeau
- School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada
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Abstract
OBJECTIVE To compare three intensive management strategies with respect to metabolic control (glycated haemoglobin, preprandial blood glucose, lipid profile, body weight, hypoglycaemic episodes) and psycho-social adaptation (quality of life, self-efficacy, stress and perceived complexity). RESEARCH DESIGN AND METHODS Fifteen adults with type 1 diabetes completed this 1-year, randomized, prospective, cross-over study. The three treatment strategies were categorized according to flexibility with insulin self-adjustments as follows: Simplified (SIMP) = meal plan based on food exchanges with no self-adjustments of insulin for food, exercise and stress; Qualitative (QUAL) = meal plan based on food exchanges with qualitative adjustment of insulin for food, exercise and stress; Quantitative (QUANT) = meal plan using carbohydrate counting with quantitative adjustment of insulin for food and qualitative adjustment for exercise and stress. All three strategies allowed for adjustments of insulin for preprandial blood glucose and the option of adjusting diet for exercise. All subjects followed each strategy for 3.5 months. Subjects kept detailed log sheets where they recorded preprandial blood glucose, insulin dosages, food intake, activity and stress level at least four times/day. The psycho-social aspects were determined with validated questionnaires that were completed before and after each strategy. RESULTS There were no statistically significant differences in metabolic control, quality of life and self-efficacy between the three strategies. The mean (+/- s.e.) for HbA1 levels (normal < 8.5%) were: Baseline: 10.9+/-0.06 and End of SIMP = 9.7+/-0.03; QUAL = 9.5+/-0.04; QUANT = 10.2+/-0.04. Body weight and serum lipid levels did not change significantly. The frequency of severe hypoglycaemic episodes for the entire study was 20 episodes/100 patient-years. Perceived complexity of treatment strategy increased (p < 0.0001) from SIMP to QUANT (least to most flexible). Although the majority of subjects (n = 11) were following a strategy similar to SIMP prior to entering the study, 12 subjects chose to continue with QUAL, three with QUANT and none with SIMP at the end of the study. CONCLUSIONS These results indicate that a strategy that allows for flexibility of self-adjustments of insulin and is not very complex (such as QUAL) may be the strategy of choice for intensive management programmes.
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Affiliation(s)
- M Kalergis
- The McGill Nutrition Centre, Royal Victoria Hospital, McGill University, Montreal, Quebec
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Ledoux M, Bertrand L, Masse´ R, Strychar I. Knowledge of cardiovascular disease risk factors and dietary practices among the Quebec population: 1979–1990. Atherosclerosis 1994. [DOI: 10.1016/0021-9150(94)93130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Greene GW, Strychar I. Participation in a worksite cholesterol education program in a university setting. J Am Diet Assoc 1992; 92:1376-81. [PMID: 1430724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three hundred ninety-six employees of a large northeastern university participated in a blood cholesterol screening and provided follow-up data about their participation in a videotape cholesterol education program. Ten percent of these employees watched the videotape program; these individuals were significantly more likely to be at high risk for cardiovascular disease than were persons who chose not to watch the videotape. Persons participating in the cholesterol education program significantly increased their nutrition knowledge and significantly decreased their fat intake compared with nonparticipants. The most important reason given for watching the videotape was "concern about my cholesterol level." Reasons given for not watching the videotape were that it was "not well advertised" or that it was shown "at an inconvenient time." Although all 98 employees at high risk for cardiovascular disease were referred to their physicians for diagnostic evaluation, one third of these employees reported not seeing their physicians. These findings indicate that worksite cholesterol screening and education programs can improve nutrition knowledge and dietary behavior; however, these programs should develop strategies to increase participation and should follow up physician referrals.
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Affiliation(s)
- G W Greene
- Department of Food Science and Nutrition, University of Rhode Island, Kingston 02881
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