8/30/17 Flashcards
Behavioral Risk Factors for Type II
Sedentary lifestyle
Overweight: also fat distribution
Smoking: increases with cigs per day and pack years
Sleep: increased if less than 5 hours or more than 9
Unhealthy Diet: red meat and sweets increase
Vitamin D deficiency
Diabetes Prevention Program
Three groups-
- Lifestyle Intervention: achieve and sustain weight loss, increase exercise, education, and dietary goals
- Metformin
- Placebo
Done to overweight patients with high risk for type II
Lifestyle had biggest decrease of incidence relative to placebo, Metformin had lower decrease
Metformin helped more relative to lifestyle changes when fatter
Weight loss was the most effective lifestyle change (better hand diet change and exercise), 1 kg weight loss resulted in 16% reduction in type II incidence
Finnish Diabetes Prevention Study
Overweight people with impaired glucose tolerance (IGT)
Control: diet instruction at start of study
Experimental Group: personal advice given routinely, >5% weight loss, reduce fat intake to less than 30%, increase fiber, exercise 30 mins a day
Experimental diet intervention had less than half of diabetes incidents
Look AHEAD
Action for health in diabetes
Adults with type II, look at incidence of cardiovascular and cerebrovascular events
Control group with usual medical care (diabetes support and education)
Experimental group had usual medical care with intensive lifestyle intervention
Intensive Lifestyle Intervention: lose 7-10% of initial weight, physical activity requirement, calorie and fat restriction
There is an additive beneficial effect to combining pharmacotherapy with lifestyle modification, acts on internal and external environment
Intervention group had better BP, A1C, and lipid levels, also lost more weight
Limitations: unblinded, weight loss from meds, mess were not u inform across groups and some people stopped taking meds
Orlistat: gastric lipase inhibitor reduces fat uptake
Outcome of studying reduction of diabetes medications with lifestyle changes
Patients can reduce the number of diabetes medications or undergo diabetes remission with lifestyle changes
4 Components of Lifestyle Changes
Dietary Consultation (Medical Nutrition Therapy)
Behavioral Modification
Increased Physical Activity Level
Weight Loss
Dietary Consultation (Medical Nutrition Therapy) for Lifestyle Changes of Type II
Optimize A1C, BP, and LDL Cholesterol (ABCs)
No universal meal plan, needs to be individualized
Components-
1. Calorie Intake: balance between calories in/out, calories out measured by total energy expenditure
- Weight Management: different amount of kcal to maintain weight due to differences in RMR, weight loss of 5-10% helps with Glu, HT, and dyslipidemia
- Consistency in Carb Intake: avoid erratic blood sugars and hypoglycemia on fixed insulin doses
- Nutritional Content: specific diet composition in glycemic reduction and CV risk reduction is uncertain, better to choose patient preference to have long term adherence
Macronutrients of Nutritional Content for Lifestyle Changes
High fiber has lower glycemic index
Little difference in A1C or CV risk with low/high carb diets independent of weight loss
Fat quality better than fat quantity, low fat diet had no effect on glycemic control, omega 3-FAs don’t improve glycemic control but help with lipid levels
Protein-
Without kidney problems: high protein diet has conflicting A1C reports, lower lipid levels
With kidney probs: reducing protein in diet doesn’t change glycemic control, CV risk, or decline in GFR
Little evidence that altering macronutrient composition has a significant effect on glycemic control independent of weight loss or effect on reducing CV risk (omega 3, high protein without kidney probs, and higher soy intake with kidney probs are possible exception)
Importance of Glucose Control on Management of Type II
Intensive blood glucose control with sulphonylureas or insulin resulted in better A1C levels, less microvascular problems but no effect on macrovascular problems
Diabetes Regimen
Varies depending on if need insulin
Involves taking meds (insulin or oral meds)
Monitor food intake and blood glucose levels
Checking for ketones
Physical activity
Planning/organizing to have supplies ready for different situations
Alerting others
Complications of no adherence to diabetes regimen
Short term:
High blood glucose, diabetic ketoacidosis, higher A1C, BP, and hospitalizations
Long term: retinopathy, neuropathy, renal disease, amputation, higher LDL, sterility, heetndisease, gastroparesis, peripheral artery disease, death
Compliance
Extent o which patient behavior matches medical advice
Factors related to nonadherence
Patient/family characteristics: adolescents, men, lower SES, minorities
Disease related characteristics: duration, course, severity(real or perceived)
Regimen related characteristics: costs outweigh benefits, side effects
Health care provider/system: need support from medical team, increased contact, and quality doctor-patient relationship
No adherence in youth
Teens more likely to be non-adherent than little kids cuz less parental influence, more peer influence, and seek independence while rebel
Parents see long term while teens are short term
Different levels of motivation and burnout to follow 💯 the whole time
Diabulimia
Involves intentional nonadherence
Skip meals or eat only “free” foods to avoid administering insulin
30% of Type I women omit insulin to lose weight by piss glucose
Not diagnosable condition
Look for increased eating but weight loss, Hyperglycemia, low energy, and frequent urination
