Publications (9) View all
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Article: Determining the Influence of Type 1 Diabetes on Two Common Eating Disorder Questionnaires.
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ABSTRACT: PurposeThis research evaluated the level of influence that having type 1 diabetes (T1DM) has on responses to questions about food choices, eating concerns, dietary restraint, and others that are included on two widely used, validated eating disorder (ED) questionnaires and examined responses to these two questionnaires from patients with T1DM and an eating disorder (ED-T1DM) and an ED-no-diabetes.Method An expert panel rated each item on the Eating Disorders Examination Questionnaire (EDE-Q) and Eating Disorders Inventory, version 3 (EDI-3) regarding T1DM level of influence on item interpretation. These questionnaires were completed by 2 matched samples (ED-T1DM, n = 48 and ED-no-diabetes, n = 96); responses were compared between the samples with particular attention to items of high T1DM influence.ResultsThe expert panel identified that 50% (19/38) of the items on the EDE-Q and 6.6% (6/91) on the EDI-3 could be highly influenced by having T1DM. Before Bonferroni correction, the 2 groups responded statistically different on 9 out of 38 items on the EDE-Q and 27 out of 91 items on the EDI-3; generally responses were healthier for those with ED-T1DM than ED-no-diabetes. Of these items, on the EDE-Q, 5 were rated high T1DM influence and on the EDI-3, 3 were rated high.Conclusion Having T1DM influences responses on ED questionnaires developed for the general population. This influence may be greater when questionnaires focus on eating, weight, and shape and result in misinterpretation of total and subscale scores by even well-trained clinicians. A careful review of individual item responses by the treatment team is warranted.The Diabetes Educator 04/2013; · 1.96 Impact Factor -
Article: Characteristics of persons with an eating disorder and type 1 diabetes and psychological comparisons with persons with an eating disorder and no diabetes.
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ABSTRACT: Describe characteristics of patients who have both an eating disorder and type 1 diabetes and compare their responses on psychological tests with those with an eating disorder and no diabetes at time of initial assessment to an eating disorder facility. A chart audit conducted on all 48 patients with ED-DMT1 who were seen collaboratively by the diabetes and eating disorder treatment teams between 2005 and 2008 at Park Nicollet Health Services and 96 (1:2) matched eating disordered controls. Diabetes was diagnosed an average of 10.2 years (SD = 9.4) before the diagnosis of an eating disorder; HbA1c at initial assessment was 11% (±3.2%). Those without diabetes reported greater depression (p = .048) and greater state and trait anxiety (p = .015 and p = .039, respectively) at initial assessment. Persons with both an eating disorder and type 1 diabetes were less psychologically compromised than their matched cohorts with an eating disorder only. These findings may not remain constant during the course of treatment.International Journal of Eating Disorders 04/2011; 45(2):252-6. · 2.95 Impact Factor -
Article: Improving blood pressure control in individuals with diabetes: a quality improvement collaborative.
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ABSTRACT: Studies show that it is difficult to achieve blood pressure (BP) targets among people with diabetes. Methods to improve BP control are needed. A quality improvement (QI) collaborative was established to improve systolic BP (SBP) control in persons with diabetes. A longitudinal study with a three-phase QI collaborative as the intervention was conducted with 51 primary care practices within 12 health care organizations in the United States. Baseline, 6-, and 12-month posteducation performance data were collected. Phase 1 began in October 2006, and all sites completed all three phases by June 2008. Sites participated on four collaborative conference calls to discuss shared data and individual site activities, as well as on monthly calls with their project consultant. Some 624 staff participated in interactive education programs, and data were collected on 11,510 patients with diabetes. All site champions stated that the collaborative supported process changes and engaged stakeholders and patients, focused staff on accurate BP measurement and treatment options, and served to identify and address gaps in outcomes. Mean SBP significantly improved from baseline (130.4 mmHg) to 6 months (127.4 mmHg; p < .001) and to 12 months (128.6 mmHg; p < .001). The proportion of patients with SBP < 130 mmHg increased from baseline (47.3%) to 6 months (56.4%; p < .001) and to 12 months (53.1%; p < .001). The proportion of patients with BP < 130/80 mmHg increased from baseline (36.8%) to 6 months (45.1%; p < .001) and to 12 months (42.2%; p < .001) A QI collaborative that provides focus, structure, and strategies to help health care organizations customize and standardize processes related to BP management can improve BP control in patients with diabetes.Joint Commission journal on quality and patient safety / Joint Commission Resources 03/2011; 37(3):110-9. -
Article: The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults.
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ABSTRACT: This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.Journal of the American Dietetic Association 12/2010; 110(12):1852-89. · 3.59 Impact Factor -
Article: Continuous glucose monitoring reveals different glycemic responses of moderate- vs high-carbohydrate lunch meals in people with type 2 diabetes.
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ABSTRACT: This single-center, meal-intervention, crossover study was conducted to determine the glycemic response to fixed meals with varying carbohydrate content. Continuous glucose monitoring was used to document the glycemic response. Participants were 14 people with type 2 diabetes on metformin only. On 4 consecutive days in March or July 2008, study participants consumed a fixed breakfast and one of two test meals (lunch) provided in random order. The two lunch types varied only in carbohydrate content; the protein, fat, fiber, and glycemic index were similar. They consumed no caloric food or beverages for 4 hours after each meal. Consuming double the carbohydrate content did not double the glycemic response variables, yet most were substantially different in glucose value (mg/dL) or minutes. General linear model analyses revealed substantial differences for peak glucose, change from baseline glucose to peak, time to return to preprandial glucose, 4-hour glucose area under the curve, and 4-hour mean glucose. Continuous glucose monitoring data provided a robust description of the glycemic response to the two meals. Such data can help improve postprandial glucose levels through more informed nutrition recommendations and synchronization of food intake, diabetes medication, and/or physical activity.Journal of the American Dietetic Association 12/2010; 110(12):1912-5. · 3.59 Impact Factor
