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The aim of this thesis is to investigate different methods of improving the glycaemic control of diabetic out-patients, within the scope of the author's training both as a therapeutic dietitian and as a teacher. Evidence is presented from the literature, which indicates that high-carbohydrate, high-fibre diets are of benefit in diabetes, that supplements of viscous fibre improve glycaemic control, and that education of the diabetic patient may help to achieve good diabetic control, provided that the patient also complies with all parameters of therapy. Three main studies have been undertaken: - (1) An educational project, to investigate the effect of a mass-education programme on compliance and control in diabetic out-patients. (2) An investigation of the effect of long-term high-fibre diets in diabetic out-patients. (3) A study of the use of guar gum in the diabetic diet. In Study 1, a large random sample of patients attending a diabetes outpatient clinic were tested by means of a detailed questionnaire, in order to assess their existing knowledge of the disease. A suitable education programme was then devised and patients were exposed to this in the clinic situation. Another sample of patients was then re-tested with the same questionnaire and statistical analysis was used to assess the effect of this programme on knowledge, compliance and control. Results indicate that, while patients' knowledge scores improved, there was no improvement in dietary compliance and also no significant change in the standard of diabetic control in the clinic population. In Study 2 we investigated the practical aspects of administering a high-fibre diet to diabetic out-patients in Cape Town, in the light of the reported benefits of diets containing large amounts of dietary fibre (OF) in the control of diabetes. Readily-available, low-cost foodstuffs with a high OF content, were incorporated into suitable, individualised high-fibre meal plans for 10 selected diabetic out-patients. Patients were closely monitored over a period of 9 months, for 3 months of which the high-fibre diet was prescribed. Various parameters of glycaemic control were recorded and analysed, and the patients' compliance to the new regimen was assessed. Only 3 patients approached the projected fibre intake, but significant negative correlations were found between the dietary fibre increments and both mean plasma glucose and mean serum triglyceride changes. These findings suggest that, were it not for poor dietary compliance, a high-fibre diet might result in significant improvement in diabetic control, and that education and motivation are of prime importance when making major changes to patients' eating habits. Study 3 investigates the use of guar gum, when incorporated into the diabetic diet in both short- and medium-term studies. This viscous fibre has been shown by workers overseas to be effective in lowering postprandial glycaemia. In this study a palatable vehicle for the gum, a digestive-type biscuit, was tested for its effect on glycaemic control when incorporated into the usual meal plans of diabetic out-patients, and also against an oral glucose load as a reference standard. It was found to be effective in reducing the post-prandial rise in blood glucose, and in improving glycaemic control, as shown by reduced fasting blood glucose values and decreased 24-hour urinary glucose excretion. The biscuit proved to be palatable and acceptable to patients, and the guar gum was effective in much smaller quantities than have previously been tested. It may therefore prove a valuable adjunct to diabetes therapy. Results of these studies indicate that compliance to therapeutic recommendations is the crux of achieving good diabetic control. Increased diabetic knowledge alone does not lead to improved diabetic control, and compliance to altered eating habits is difficult to achieve unless prior education and motivation has taken place. The simplest means of achieving better glycaemic control of diabetes appears to be the use of a supplement of viscous fibre, which will improve the glycaemic response to the patients' usual meals.

by Annie Chi Kwan Lam. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 112-119). / Abstracts in English and Chinese ; questionnaires also in Chinese. / Acknowledgements --- p.i / Abstract --- p.ii-vi / List of Figures --- p.vii / List of Tables --- p.vii-x / List of Abbreviations --- p.xi / Table of Contents --- p.xii-xvi / Chapter Chapter One: --- Background / Chapter 1.1 --- Diabetes Mellitus: A public health burden / Chapter 1.1.1 --- Definition and Health Consequences --- p.2 / Chapter 1.1.2 --- Prevalence of Type 2 Diabetes Mellitus in Asia --- p.3 / Chapter 1.1.3 --- Prevalence of Type 2 Diabetes Mellitus in the Hong Kong Chinese Population --- p.4 / Chapter 1.1.4 --- Medical Burden of Diabetes Mellitus in Hong Kong --- p.7 / Chapter 1.2 --- Clinical Intervention To Improve Glycemic Control / Chapter 1.2.1 --- The United Kingdom Prospective Studies (UKPDS) --- p.8 / Chapter 1.2.2 --- The Diabetes and Complications Trial (DCCT) --- p.9 / Chapter 1.2.3 --- Another Clinical Trial of Lifestyle Intervention --- p.10 / Chapter 1.2.4 --- Physical Activity in Diabetes Management --- p.12 / Chapter 1.3 --- Dietetic Situation in Hong Kong / Chapter 1.3.1 --- Survey of the Hong Kong Dietetics Situation --- p.15 / Chapter 1.3.2 --- Current Situation of Prince of Wales Hospital --- p.17 / Chapter 1.3.3 --- Diabetes Knowledge and Compliance Level in Hong Kong Patients --- p.22 / Chapter 1.4 --- Medical Nutrition Therapy and Practice Guidelines / Chapter 1.4.1 --- Definition --- p.24 / Chapter 1.4.2 --- Development of the Practice Guidelines --- p.24 / Chapter 1.4.3 --- Recommended Procedure for the Practice Guidelines in Type 2 Diabetic Patients --- p.28 / Chapter 1.5 --- Study Purpose and Objectives --- p.32 / Chapter Chapter Two: --- Study Design and Method / Chapter 2.1 --- Research Design --- p.34 / Chapter 2.2 --- Sample Selection --- p.34 / Chapter 2.2.1 --- Method of Randomization --- p.35 / Chapter 2.2.2 --- Sample Size Calculation --- p.36 / Chapter 2.2.3 --- Inclusion Criteria --- p.37 / Chapter 2.2.4 --- Exclusion Criteria --- p.38 / Chapter 2.3 --- Summary of Patient Procedure --- p.38 / Chapter 2.3.1 --- Definition Of The Two Treatments --- p.41 / Chapter 2.3.2 --- Research Procedure For PGC Group --- p.43 / Chapter 2.3.3 --- Research Procedure For CC Group --- p.49 / Chapter 2.4 --- Outcome Measures / Chapter 2.4.1 --- Anthropometrics Variable --- p.50 / Chapter 2.4.2 --- Laboratory Data --- p.51 / Chapter 2.4.3 --- Pre-testing For Questionnaires --- p.51 / Chapter 2.4.4 --- Dietary Variables --- p.52 / Chapter 2.4.5 --- Measurement of Diabetes Knowledge --- p.53 / Chapter 2.4.6 --- Measurement of Barriers To Diet Compliance --- p.54 / Chapter 2.4.7 --- Measurement of Physical Activity --- p.54 / Chapter 2.4.8 --- Measurement of Barriers To Exercise Compliance --- p.54 / Chapter 2.4.9 --- Measurement of Overall Compliance in MNT --- p.55 / Chapter 2.5 --- Statistical Analysis --- p.57 / Chapter 2.6 --- Ethics --- p.58 / Chapter Chapter Three: --- Results / Chapter 3.1 --- Subjects and Response Rate --- p.60 / Chapter 3.1.1 --- Baseline Characteristics of the PGC and CC Group --- p.61 / Chapter 3.2 --- Results of Intervention Process Between PGC and CC Group / Chapter 3.2.1 --- Attendance Rate --- p.67 / Chapter 3.2.2 --- Total Patient-Dietitian Contact Time --- p.67 / Chapter 3.2.3 --- Satisfaction With Dietetic Services --- p.68 / Chapter 3.2.4 --- Other Alternatives Treatment --- p.69 / Chapter 3.2.5 --- Changes In Medical Therapy After Intervention --- p.69 / Chapter 3.2.6 --- Hospital Admission --- p.71 / Chapter 3.3 --- Outcomes - Questionnaires Results Between PGC and CC Group / Chapter 3.3.1 --- Food Frequency Questionnaire --- p.72 / Chapter 3.3.2 --- Physical Activity Questionnaire --- p.72 / Chapter 3.3.3 --- Diabetes Knowledge --- p.72 / Chapter 3.3.4 --- Barrier To Diet Compliance --- p.72 / Chapter 3.3.5 --- Barrier To Exercise Compliance --- p.73 / Chapter 3.3.6 --- Overall Medical Nutrition Therapy Compliance --- p.78 / Chapter 3.4 --- Outcomes - Anthropometry Results Between PGC and CC Group --- p.79 / Chapter 3.5 --- Outcomes - Laboratory Results Between PGC and CC Group / Chapter 3.5.1 --- Glycemic Control --- p.83 / Chapter 3.5.2 --- Lipid --- p.84 / Chapter Chapter four: --- Discussion and Conclusion / Chapter 4.1 --- Enrollment / Chapter 4.1.1 --- Response Rates --- p.91 / Chapter 4.1.2 --- Behavior Change Model --- p.92 / Chapter 4.1.3 --- Participation of Subjects --- p.93 / Chapter 4.1.4 --- Randomization --- p.93 / Chapter 4.2 --- Measurements / Chapter 4.2.1 --- Questionnaire --- p.94 / Chapter 4.2.2 --- Blinding Process --- p.94 / Chapter 4.2.3 --- Laboratory --- p.94 / Chapter 4.3 --- Outcomes / Chapter 4.3.1 --- Questionnaire Outcomes --- p.95 / Chapter 4.3.2 --- Anthropometry Outcomes --- p.100 / Chapter 4.3.3 --- Glycemic Outcomes --- p.102 / Chapter 4.3.4 --- MNT Process Outcomes --- p.103 / Chapter 4.3.5 --- Limitations --- p.104 / Chapter 4.4 --- Clinical Significance and Implications --- p.104 / Chapter 4.5 --- Conclusions and Recommendations --- p.110 / References --- p.112 / Appendices --- p.120

This diploma thesis is focused on the study of the phenomenon of the non-compliance, or more specifically on the study of the phenomenon of the non-compliance of patients with diagnosis of diabetes mellitus. The theoretical part contains a discussion of the phenomenon of the non-compliance, of a problematics of the diabetes mellitus and associated complications and comorbidities. The practical part is based on the statistical evaluation of the specifically prepared survey of patients of the private ambulance of diabetology and endocrinology in Trutnov. The results of survey were processed to obtain contingency tables, and then the correlations between individual aspects of compliance or non-compliance were studied using statistical correlation analysis.

The Master's thesis entitled "Gestational Diabetes Diet" deals with the issue of eating habits and a lifestyle of women diagnosed with gestational diabetes mellitus during pregnancy. The theoretical part of the thesis describes the definition, causes and a mechanism of origin, consequences for mother and fetus and also deals with the diagnostic procedures and all possibilities of treatment of this disease. In this part, the diagnostic method analyzed by using the oGTT stress test and a diabetic diet - that together with other preventive measures (mainly physical aktivity) is the first choice in the treatment of pregnancy diabetes - are described in more details. The practical part of this master's thesis contains the results of a questionnaire survey in two groups of pregnant women - with already diagnosed gestational diabetes and before its diagnosis in the oGTT test. It also contains the results of the analysis of women with GDM diets. The analysis were processed by the NutriPro Expert diet program and the results are then compared with the current nutritional recommendations of the Czech Republic for pregnant and nursing women. The aim of this work was to map the eating habits and lifestyle of women with gestational diabetes and find out whether they meet current nutritional recommendations or...

Bakgrund: I den systematiska litteratur studien Mat vid diabetes (SBU 2010) framgår det att lågkolhydratkost har likartade metabola effekter hos personer med diabetes i jämförelse med en traditionell lågfettskost. Trotts dessa råd visar en undersökning ifrån samma studie att endast 18 % av de tillfrågade sjuksköterskorna kliniskt tillämpade denna typ av kostintervention. Detta tycks vara problematiskt vilket nyligen uttryckts i en rad olika mediala sammanhang. Utöver denna debatt har vi idag också en epidemiskt stor utbredning av patienter med typ 2 diabetes mellitus vilket ställer krav på de allt mer begränsade resurser som finns inom vård och omsorg.  Syfte: Syftet var att beskriva lågkolhydratkostens metabola påverkan hos patienter med Diabetes Mellitus typ 2. Metod: Den elektroniska sökningen av artiklar utfördes i PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) samt PMC (2011-2014). 13 artiklar bedömdes utifrån studiedesign, metabola markörer, intervention/kontrollgrupp, inklusions och exklusionskriterer vara lämpliga för studien. Resultat: En övergripande majoritet studierna visade på att lågkolhydratkosten gav signifikant förbättrade metabola markörer och framförallt gällande HbA1c och HDL-kolesterol. Endast en studie visade på ett negativt icke-signifikant resultat. Konklusion: Lågkolhydratkost förefaller utifrån studiens syfte och resultat som ett fullgott alternativ till den traditionella diabeteskost som utgör stora delar av den kostbehandling som patienter med T2DM får idag. Men kan innebära ett stort ansvar i det arbetsätt som sjuksköterskan tillämpar för att stödja och hjälpa en patient med T2DM att nå en god egenvård, hälsa och metabolkontroll  Nyckelord: Typ 2 diabetes mellitus. Lågkolhydratkost. Traditionell diabeteskost. Chronic Care Model. Egenvård. Empowerment. / Background: The systematic literature review Mat vid diabetes (SBU 2010) indicates that a low carbohydrate diet possesses similar metabolic effects in people with diabetes compared to a traditional low-fat diet. Contrary to this advice, a review from the same study portrayed that only 18% of the surveyed nurses clinically applied this type of diet intervention. This seems to be problematic, as was recently expressed in a variety of media. In addition to this debate, health care now also face a widespread epidemic of patients with type 2 diabetes mellitus which in turn puts the increasingly diminished and limited resources in health care under additional pressure.  Aim: The aim of this study was to describe a low-carbohydrate diet and its metabolic effects in patients with Diabetes Mellitus type 2. Method: Included articles in this review was found by searching PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) and PMC (2011-2014). 13 articles were assessed to be eligible for this review by assessing study-design, metabolic markers, intervention / control group, inclusion and exclusions criteria.  Results: An overall majority of studies proved that a low carbohydrate diet could result in significantly improved metabolic markers, and in particular the HbA1c and HDL cholesterol. Only one study showed a negative non-significant result. Conclusion: A low-carbohydrate diet seems based on our findings as a viable alternative to the traditional diabetic diet which constitute a large part of the diet treatment that patients with T2DM receives from current healthcare. But this in turn implies that a greater responsibility is taken by the nurse in order to support and help a patient with T2DM to achieve a good self-care, health and metabolic control. Keywords: Type 2 diabetes mellitus. Low carbohydrate diets. Traditional diabetic diet. Chronic Care Model. Self-care. Empowerment.

Introduction: Diploma thesis deals with issues of gestational a pregestational diabetes and the influence od diabetic diet during pregnancy on eating habits. Goals: The theoretical part is focused on general summary of diabetes during pregnancy - its characteristic, epidemiology, risk factors, complications, treatment including glycemic self- monitoring, observation during and after the childbirth. The last part is focused on education, as the important part of the therapy. The emphasis is put on the practical part, which analyse eating habits including measures regime of women dealing with gestational a pregestational diabetes, before and after the pregnancy. Crucial task was the comparison of choice of the food, frequency of monitored food and the regularity of eating. Methods: Research took place through the anomyous questionnaires, obtained on Gynecological-obstetrical clinic of General hospital in Prague. Questionnaires were filled out by woman diagnosed gestational and pregestational diabetes type 1. The discovered data are given into graphs and charts and part of the thesis is dedicated to the analysis of the data. Outcome: According to researched data we can say, that the eating habits before the pregnancy are not sufficient in any of the groups. Due to pregnancy and resulting diatetic...

Introdução: A contagem de carboidratos (CCH) é reconhecida pela American Diabetes Association (ADA) como uma importante ferramenta para auxiliar no controle glicêmico de pacientes com diabetes mellitus (DM). Objetivo: Avaliar a eficácia de material educativo fotográfico na orientação de CCH para adolescentes com DM. Método: Uma amostra de 76 adolescentes foi randomizada entre dois grupos que receberam orientação de CCH com material educativo fotográfico (Foto) ou lista de alimentos equivalentes (Lista). A intervenção aconteceu em três etapas. Na primeira, foram coletados dados como sexo, idade, peso, altura e escolaridade dos adolescentes; escolaridade dos pais e valor de hemoglobina glicada. Um formulário foi aplicado para avaliar o conhecimento prévio sobre CCH. Na segunda etapa, após um mês ou mais, os adolescentes responderam por telefone perguntas (Quiz) relacionadas ao tema com o intuito de reforçar a orientação de CCH. Na terceira etapa, dois dias após a aplicação do Quiz, os adolescentes foram direcionados à cozinha experimental para observar porções de alimentos in natura e responder a um formulário sobre a quantidade em gramas ou equivalentes de carboidratos presente nas porções. Adotou-se uma significância estatística quando p<0,05. Resultado: Cinquenta e quatro adolescentes finalizaram a pesquisa; não houve diferenças entre este grupo e o grupo perdido; 79,7% eram do sexo feminino; 51,8% foram alocados no grupo Foto e 48,1%, no grupo Lista. A média de idade foi de 13,8 ±2,0 anos; IMC 21,0 ±3,2 kg/m2; anos de escolaridade dos adolescentes 7,9 ±1,5 anos e dos pais 8,0 ± 3.8 anos. O conhecimento sobre CCH antes da intervenção foi semelhante nos dois grupos. Após a intervenção houve um incremento significativamente maior na pontuação em teste para avaliar a CCH no grupo Foto quando comparado ao grupo Lista (Foto: 2,5 vs Lista: 1,0, p=0,03). Conclusão: O material educativo fotográfico foi mais eficaz para compreender e memorizar a contagem de carboidratos neste grupo de adolescentes com DM / Introduction: Carbohydrate counting is recognized by the American Diabetes Association (ADA) as an important tool to assist in the control of blood glucose of diabetes mellitus (DM) patients. Objective: To evaluate the efficacy of photographic educational material on carbohydrate counting for DM adolescents. Method: A sample of 76 adolescents was randomly distributed between 2 groups: those who received orientation on carbohydrate counting with photographic educational material (Photo) or with a list of food exchange (List). The intervention followed 3 steps. First, data was collected on age, gender, BMI, HbA1c, adolescents and parents schooling; answer sheets were applied to evaluate previous knowledge on carbohydrate counting. At the second step, after at least 1 month, adolescents answered a Quiz by phone aiming to reinforce orientation. At the third step, two days after the second one, adolescents were directed to an experimental kitchen to interact with portions of real food and provide answers on amount of carbohydrate. Statistical difference was considered when p<0,05. Results: Fifty four adolescents finished the research, there was no difference between this group and the one with lost of follow-up; 79.7% were female; 51.8% was allocated at the Photo group and 48.1% at the List group. The mean age was 13.8 ± 2.0 years, BMI 21.0 ± 3.2 kg/m2, adolescents schooling 7.9 ± 1.5 years, the parents schooling 8,0 ± 3.8 years. Both groups achieved equivalent scores to tests applied to evaluate previous knowledge. The score gain was significantly higher after the intervention among those who belonged to the Photo group when compared with those of the List group (Photo: 2.5 vs List: 1.0 p= 0,03). Conclusion: The photographic educational material had a greater efficacy in this group of DM adolescents to understand and memorize on carbohydrate counting

Introdução: A contagem de carboidratos (CCH) é reconhecida pela American Diabetes Association (ADA) como uma importante ferramenta para auxiliar no controle glicêmico de pacientes com diabetes mellitus (DM). Objetivo: Avaliar a eficácia de material educativo fotográfico na orientação de CCH para adolescentes com DM. Método: Uma amostra de 76 adolescentes foi randomizada entre dois grupos que receberam orientação de CCH com material educativo fotográfico (Foto) ou lista de alimentos equivalentes (Lista). A intervenção aconteceu em três etapas. Na primeira, foram coletados dados como sexo, idade, peso, altura e escolaridade dos adolescentes; escolaridade dos pais e valor de hemoglobina glicada. Um formulário foi aplicado para avaliar o conhecimento prévio sobre CCH. Na segunda etapa, após um mês ou mais, os adolescentes responderam por telefone perguntas (Quiz) relacionadas ao tema com o intuito de reforçar a orientação de CCH. Na terceira etapa, dois dias após a aplicação do Quiz, os adolescentes foram direcionados à cozinha experimental para observar porções de alimentos in natura e responder a um formulário sobre a quantidade em gramas ou equivalentes de carboidratos presente nas porções. Adotou-se uma significância estatística quando p<0,05. Resultado: Cinquenta e quatro adolescentes finalizaram a pesquisa; não houve diferenças entre este grupo e o grupo perdido; 79,7% eram do sexo feminino; 51,8% foram alocados no grupo Foto e 48,1%, no grupo Lista. A média de idade foi de 13,8 ±2,0 anos; IMC 21,0 ±3,2 kg/m2; anos de escolaridade dos adolescentes 7,9 ±1,5 anos e dos pais 8,0 ± 3.8 anos. O conhecimento sobre CCH antes da intervenção foi semelhante nos dois grupos. Após a intervenção houve um incremento significativamente maior na pontuação em teste para avaliar a CCH no grupo Foto quando comparado ao grupo Lista (Foto: 2,5 vs Lista: 1,0, p=0,03). Conclusão: O material educativo fotográfico foi mais eficaz para compreender e memorizar a contagem de carboidratos neste grupo de adolescentes com DM / Introduction: Carbohydrate counting is recognized by the American Diabetes Association (ADA) as an important tool to assist in the control of blood glucose of diabetes mellitus (DM) patients. Objective: To evaluate the efficacy of photographic educational material on carbohydrate counting for DM adolescents. Method: A sample of 76 adolescents was randomly distributed between 2 groups: those who received orientation on carbohydrate counting with photographic educational material (Photo) or with a list of food exchange (List). The intervention followed 3 steps. First, data was collected on age, gender, BMI, HbA1c, adolescents and parents schooling; answer sheets were applied to evaluate previous knowledge on carbohydrate counting. At the second step, after at least 1 month, adolescents answered a Quiz by phone aiming to reinforce orientation. At the third step, two days after the second one, adolescents were directed to an experimental kitchen to interact with portions of real food and provide answers on amount of carbohydrate. Statistical difference was considered when p<0,05. Results: Fifty four adolescents finished the research, there was no difference between this group and the one with lost of follow-up; 79.7% were female; 51.8% was allocated at the Photo group and 48.1% at the List group. The mean age was 13.8 ± 2.0 years, BMI 21.0 ± 3.2 kg/m2, adolescents schooling 7.9 ± 1.5 years, the parents schooling 8,0 ± 3.8 years. Both groups achieved equivalent scores to tests applied to evaluate previous knowledge. The score gain was significantly higher after the intervention among those who belonged to the Photo group when compared with those of the List group (Photo: 2.5 vs List: 1.0 p= 0,03). Conclusion: The photographic educational material had a greater efficacy in this group of DM adolescents to understand and memorize on carbohydrate counting