Provincial Diabetes Program’s New Initiative in Diabetes ... · T 1/3 cup of Wheat Chex® T 2/5 cup of cooked oatmeal T one slice of whole grain bread T ½ a whole-grain English

Primary Care Division16 Garfield StreetPO Box 2000, Charlottetown, P E C1A 7N8

June, 2010

Vol. 2 Issue 1

Provincial Diabetes Program’s New Initiative in Diabetes Education

This spring, the Provincial DiabetesProgram introduced a new format for clientswishing to receive diabetes education. Inthe past, clients with diabetes receivedclassroom education, delivered by thediabetes educator in a “lecture style”format. The two classes were designed toallow the attendee to hear the presentationabout diabetes and ask questions.

The new educational program involves theuse of conversation maps. These maps,created by Health Interactions incollaboration with the International DiabetesFoundation and sponsored by thepharmaceutical company Lilly, make itpossible to create an interactiveexperience.

Conversation Map tools engage patientswith an interactive verbal and visuallearning experience, which can enablethem to better internalize information. Studies have shown that we retainapproximately 10% of what we read and20% of what we hear. If we are able tosee, hear, read and actively participate in adiscussion, we are able to retain 70% of theinformation. This will help clients as theytry to self-manage their diabetes.

Classes for newly diagnosed clients consistof two 3 hour sessions. During theseinteractive classes, diabetes educators use acombination of different maps on topics suchas : “Living with Diabetes” “How DiabetesWorks”, “Healthy Eating and Keeping Active”.

There are other maps that cover topics suchas “Starting Insulin” and “Living in a Familywith Type 1 Diabetes”

Within the Provincial Diabetes Program, weare happy to have Trish Collins, RN, CDE asour lead trainer in this new initiative. Trishserved as a consultant to Lilly in thedevelopment of the Canadian edition of thesemaps and has provided the training for all ofour provincial program staff.

Clients interested in attending class must pre-register at their local Provincial DiabetesProgram clinic site.

In this issue:• Making Connections - Diabetes Workshop• Whole Grain verses Whole Wheat?• Canadian Diabetes Association Tool Kit• Prince Edward Island Diabetes Trends

Making Connections - Diabetes Workshop

The Provincial Diabetes Program educatorsrecently presented two day long workshops ondiabetes for community health careprofessionals. These workshops were held onJune 2nd at Credit Union Place in Summerside,and repeated on June 8th at UPEI campus inCharlottetown.

In total, over 130 people attended theworkshops and both sessions were filled tocapacity. Those in attendance included nursesand dietitians from home care and long termcare, as well as nurses from correctionalservices, and family health centres, communitypharmacists and LPN students.

Special thanks to two pharmacists Sue EllenHamill, who presented in Summerside and

Kilby Rinco, who presented in Charlottetown.Both speakers gave an excellent overview oforal diabetes agents.

The day also included presentations by ourown program staff on self-management, insulin

therapy, carbohydrate counting, nutrition and

older adults, insulin pump therapy and anoverview of our diabetes program.

The afternoon provided the opportunity forattendees to rotate through interactive stationson such topics as blood glucose meters, insulinpens, foot care, emotional and mental wellbeing, physiology of Type 2 diabetes, treatmentof high and low blood sugar and food portions.

Evaluations from attendees were very positive. People enjoyed the variety of topics presentedand the opportunity to ask questions during theafternoon stations.

Whole Grain verses Whole Wheat?(submitted by Libby Logan, Diabetes Nutrition Educator)

The term Whole Grain refers to the type offiber that comes from plant or cereal grains.These include wheat, rice, oats, barley, corn,wild rice and rye as well as quinoa and

buckwheat. In a grain kernel, there are 3 parts- the outer bran, the endosperm and thegerm. Researchers believe it is not onespecific entity of the grain kernel but thewhole package that is working together tofight disease.

Whole grain foods are those made thatcontain all 3 parts of the kernel, for exampleoats or brown rice. Refined grains are thosethat have had the germ and the outer layer ofbran removed. Examples include white flour,Cream of Wheat, white rice. Losing the germand the bran layer results in the loss of fiberas well as vitamins and minerals. In Canada,manufacturers are required to ‘enrich’ whiteflour with several vitamins and iron but theyare still lacking in the nutrients and fiber that100 % whole grains contain. As well inCanada, whole wheat flours may have someof the germ removed so 100% whole wheatbread may not be a whole grain food choice.It is still a nutritious choice that will contributeto your overall daily fiber intake. Also, bewarethat foods claiming to be multi grain andorganic breads/cereals, 100% wheat or “highfiber” are not necessarily whole grain.

Canadian recommendations are that we eat6-8 servings from the ‘grain’ group and thatat least 3 of these servings per day comefrom ‘whole grain’ food choices. Wholegrain foods will be labeled with a distinctiveblack and gold “Whole Grain Stamp”.

The best way to ensureyou are getting wholegrains is to read the ingredient list andensure that the word “whole”is listed in frontof the grain and is one of the first 3ingredients. This is not as easy as it sounds.

Marketing agencies are very keen on makingall products appear to be good sources ofwhole grains/fiber whether they are or not.

Here are a few familiar products availabletoday that supply about 16 grams of wholegrain:T 4 Triscuit® crackers

T 2/3 cup of Cheerios®

T 1/3 cup of Wheat Chex®

T 2/5 cup of cooked oatmeal

T one slice of whole grain bread

T ½ a whole-grain English muffin

T 1/3 cup cooked whole-wheat pasta

T 1/3 cup cooked brown rice, bulgur,barley or other cooked

Here are some tips to make at least one half ofyour grain products whole grain each day:< eat a variety of whole grains such as

barley, brown rice, oats, buckwheat,quinoa, and wild rice

< enjoy a variety of whole grain breads aswell as whole wheat pastas, brown rice,oatmeal daily

< make sure the word “whole” is listed infront of the grain in the ingredient list.

< choose whole wheat, rye orpumpernickel varieties of bread, bagels,pita bread and tortilla to eat withsandwich fixings

< check for the “Whole Grain Stamp”somewhere on the package

References: www.wholegrainscouncil.org www.hc-sc.gc.ca/fn-an/nutrition/whole-grain-entiers-eng.

www.hc-sc.gc/fn-an/alt_formats/npfb-dgpsa

Canadian Diabetes Association Tool Kit

The Canadian Diabetes Association Tool Kit forthe Prevention and Management of Diabetes inCanada is a handy reference for healthcareprofessionals which bundles a comprehensivecollection of the six major themes from the2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes inCanada:" diabetes and cardiovascular disease" organization of care" footcare

" pregnancy and children" lifestyle and physical activity" access to and promotion of

educational services.

These various themes are being releasedevery 4 to 6 months over the next two years. So far this committee has launched twothemes: cardiovascular risk assessment &reduction, and organization of care.The tool kit can be ordered for free throughthe CDA website: www.diabetes.ca

Theme #1: Cardiovascular Risk Assessment and Reduction:

Heart disease is currently the number onecause of death for Canadians living withdiabetes. As such, the information includedin this first instalment of the CPG Tool Kitemphasizes the importance of earlydiagnosis and management of diabetes andits associated cardiovascular risk factors. Released in June 2009, the CardiovascularRisk Assessment and Reduction theme,contains a number of current, evidence-based clinical recommendations andclinically-oriented practical information aboutdiabetes and cardiovascular risks of value toboth patients and physicians, including:

• a short synopsis of the key information oncardiovascular risk from the CanadianDiabetes Association 2008 ClinicalPractice Guidelines;

• a clinical tool (laminated two-sided card)with an algorithm to assist healthcareprofessionals with risk assessment,vascular protection, and screening

• a patient-focused tool to help Canadiansliving with diabetes better understand therisks of cardiovascular disease.

Also, healthcare professionals will learn:

• the major changes to the vascularprotection recommendations from the 2003Clinical Practice Guidelines;

• how to identify individuals at high risk ofvascular events

< how to reduce the risk of cardiovascularevents

< what coronary artery disease screening testsshould be done

Theme #2: Organization of Care:

Featured on the CDA website this month is avideo that demonstrates an “8 Minute DiabetesFocused Clinic Visit”http://www.diabetes.ca/Files/ooc-videos/consumer/index.html

This video, features Dr. Ian Blumer and Dr.Maureen Clement, both contributors to the 2008Clinical Practice Guidelines. An organized clinicvisit includes:• having the client come to the appointmentprepared (ie. necessary blood tests completed,blood glucose values recorded and brought to thevisit)

• having a systematic recall process withinyour office environment

• using clinical flow sheets• macrovascular review • microvascular review• glycemic control review• goal setting / appointment for next visit

Prince Edward Island Diabetes Trends

In March 2010, the Chief Health Office,Epidemiology Unit released the “Prince EdwardIsland Diabetes Trends 2000-2006" report.

Some key messages within this documentinclude:< In PEI, the age standardized prevalence ofdiagnosed diabetes increased by almost 40%,from 3.9% in 2000 to 5.3% in 2006.

< The percent of people living with diabetes inPEI and in Canada are similar however bothare increasing over time.

< The number of new cases of diabetes inPrince Edward Island (incidence) between2000 and 2006 has remained relativelyconstant over time with an average of 842cases per year.

< In 2006, the prevalence of diabetes inmales (8.0%), aged 20 and over, issignificantly higher than females (6.1%)

< Adults aged 20 years and over withdiabetes were hospitalized more often thanthose without diabetes including 16 timesmore often with lower limb amputation, 6 times more often with chronic kidneydisease, 5 times more often with heartattacks, 4 times more often with heartfailure and ischemic heart disease and 3times more often with strokes.

< In 2006, Islanders with diabetes hadhospital stays 3 times longer than Islandershospitalized without diabetes. They alsohad 2 times as many visits to familyphysicians and 2 times as many visits tospecialists.

The entire report is available for viewing at:http://www.gov.pe.ca/photos/original/dohw_epi_diab10.pdf

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