Plate, Pyramid or Perseverance? Medical Nutrition Therapy for Diabetes Iris Thiele Isip Tan MD, MSc Associate Professor, UP College of Medicine Chief, UP Medical Informatics Unit July 2014 Melons by kisa12 http://www.freeimages.com/photo/863924 Monday, July 14, 14
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
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Plate, Pyramid or
Perseverance?Medical Nutrition
Therapy for Diabetes
Iris Thiele Isip Tan MD, MScAssociate Professor, UP College of Medicine
Chief, UP Medical Informatics Unit
July 2014
Melons by kisa12http://www.freeimages.com/photo/863924
EAT MOSTUse one or more of these foods as the basis of every mealVegetables, legumes, lentils, noodles, rice, bread, grains, barley, wholegrain cereals, fresh fruit (non-sweet)
EAT MODERATELYHave small servings of protein-rich foodsfish, seafood, eggs, lean meat, skinless chicken, low-fat cheese, low-fat yoghurt, low-fat milk, nuts
EAT LEASTMinimise fats, sugars, salt and alcoholbutter, oil, ghee, cream, coconut milk and cream, processed meat, fried foods, preserved or processed foods, pastries, sweets, biscuits, soft drink
Fresh vegetables 6 by MeiTenghttp://www.freeimages.com/photo/1441972
Bits-n-bites Truffle by Subhadipinhttp://www.freeimages.com/photo/1437365
Japanese sushi by chokingxihttp://www.freeimages.com/photo/1443887
Does not require math skills or high reading level
✓elderly✓need to lose
weight✓hospitalized
needing “survival” information
Challenging for those whom rice is a staple and those who enjoy only a limited variety of vegetables
Brown et al Diabetes Spectrum 2001Monday, July 14, 14
Tight fist = 1/2 cup Handful = 1 cup
Palm = 3 oz
Thumb = 2 tbsp or 1 oz
Thumb tip = 1 tspHand guides
for portion control
Monday, July 14, 14
UNITE CPG9.1.4 Hospital-based nutrition advice
a. Calculation of caloric requirement & macronutrient distributionb. Exchanges or CHO countingc. How to read food labelsd. Glycemic indexe. Meal replacement
Weighing my food by Judy Baxterhttps://flic.kr/p/7Jod31
Daily meal plan based on a set amount of servings from each category
Monday, July 14, 14
Diabetic ExchangesStarch Meat/meat
substitutesNon-starchy vegetables
FatsFruit Milk
• Allows a person to measure rather than weigh food• Any food may be substituted for another within the same
food category• Free food contains <20 cal (can be eaten in any amount
spread throughout the day) i.e. catsup, soy sauce, spicesMonday, July 14, 14
GLYCEMIC INDEX (GI)
Increase in blood glucose (over fasting level) in 2 h following
ingestion of 50 g CHO
Low GI0-55
Intermediate56-69
High GI>70
Llona A. Nutr Hosp 2006;21:53-59
Monday, July 14, 14
Issues with GIOnly accounts for CHO type (not total amount)Measures response to individual food consumed in isolationGI for any particular food item highly variableInaccurate predictor of postprandial response in diabetes
Dietary CHO (Amount & Type) in the Prevention & Management of Diabetes: American Diabetes Association Position Statement (2004)
Monday, July 14, 14
UNITE CPG9.2 Are sucrose & sucrose-containing foods allowed?
Individuals with diabetes need not avoid sucrose or table sugar as small amounts do not adversely affect glycemic control (Level 3, Grade B). Table sugar when consumed,
should however replace other carbohydrate in the meal plan.
sugar cube by Zeppelin5http://www.freeimages.com/photo/670527
Objective To determine if 3x a week SMS will improve
adherence to diet and exerciseSecondary Objective
To determine the mean change in body weight, BMI & HbA1c
JAFES 2013;28(2):143-9
Monday, July 14, 14
I
M
O
P
Use of SMS for the Management of Type 2 Diabetes Mellitus: A Randomized Controlled TrialTamban C, Isip Tan IT & Jimeno C JAFES 2013;28(2):143-9
104 patients with T2DM, personal owner of a cellphone and attended at least 1 lecture by the DM educator
Control group (n=36) vs SMS group (n=46) for 6 monthsSMS 3x a week
Primary: Adherence to diet & exercise at 3 and 6 months (interview by DM educator and patient diary)Secondary: Mean change in body weight, BMI & HbA1c at 3 and 6 months
Randomized controlled trial
Monday, July 14, 14
Adherence to diet:2-3 main meals >4 days/week
Non-adherence to diet:1 main meal <3 days/week
SMS scheduleMonday: DietWednesday: ExerciseFriday: Consequences of non-adherence to DM management
Pyramid on a plate by Steve Garfieldhttps://flic.kr/p/HA2Qf
The Nelson by Pamela Grahamhttps://flic.kr/p/ebWV1w
Tamban C, Isip Tan IT & Jimeno C JAFES 2013;28(2):143-9
Week 1: Eat vegetables and fruits everyday. Follow the dietary advice given by the doctor and dietitian.Week 2: Avoid soft drinks and chocolates. Follow the dietary advice given by the doctor and dietitian.Week 3: Avoid fried and salty foods. Follow the dietary advice given by the doctor and dietitian.Week 4: Avoid fatty and cholesterol-rich foods. Follow the dietary advice given by the doctor and dietitian.
Mobile phone in hand by sqbackhttp://www.freeimages.com/photo/1307593
Pyramid on a plate by Steve Garfieldhttps://flic.kr/p/HA2Qf
One, Two ... Count my food.Three, Four ... Exercise more.Five, Six ... Small meals I fix.Seven, Eight ... Now how’s my weight?Nine, Ten ... Start again.