Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-5

INTRODUCTION

It is well documented that nutrition therapy can help improve glycemic control (1). It can lead to a decrease in glycated hemoglobin (A1C) of 1.0 to 2.0% (2–4) and, when used in combination with other components of diabetes care, nutrition therapy can further improve clinical and metabolic outcomes. The overall goal of diabetes management is “to help individuals with diabetes and their families gain the necessary knowledge, life skills, resources and support needed to achieve optimal health” (5). This requires a team effort that includes the input of diabetes health-care (DHC) professionals and the person with diabetes. It is recommended that a registered dietitian, knowledgeable and skilled in the field of diabetes, provide nutrition care and education. People from a lower socioeconomic status may prefer individual counseling (6), while group education has been shown to be more effective than individual counseling if principles of adult education are incorporated (i.e. hands-on activities, problem solving, role playing and group discussions) (7). Web-based care management has been shown to improve glycemic control (8). Regardless of delivery method, principles of self-management education should be utilized (see Chapter 2: Foundations of Diabetes Self-Management Education and Support and Chapter 11: Self-Management Education and Support: Prgram Development). Nutritional management seeks to improve or maintain the following (5): • The quality of life of people with diabetes and their families, by teaching management techniques that include the entire family and caregivers in decision making while enhancing the individual’s personal sense of control and well-being. • The physiological health of people with diabetes, by establishing and maintaining as near- normal blood glucose (BG) and lipid levels as possible, and by being aggressive in preventing and/or treating diabetes-related complications and any concomitant conditions. • The nutritional status of people living with diabetes, recognizing that their micro- and macronutrient requirements are similar to those of the general population. Nutritional counseling should be individualized and evaluated regularly. Consideration must be made for the person’s age, type and duration of diabetes, concurrent medical therapies, treatment goals, values, preferences, needs, culture, lifestyle, economic status, activity level, abilities, readiness to change and barriers to healthy eating.