Gioconda Padilla’s research while affiliated with Costa Rican Institute for Research and Education on Nutrition and Health and other places

Objective. To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these persons' felt needs. Methods. Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable. Results. We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 ± 79 mg/dL (average and standard deviation) to 157 ± 48 mg/dL (P

To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these person's felt needs. Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable. We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 +/- 79 mg/dL (average and standard deviation) to 157 +/- 48 mg/dL (P < 0.05), and glycosylated hemoglobin (HbA1c) went from 11.3% +/- 2.4% to 9.7% +/- 2.3% (P = 0.05). There were no significant changes in body weight or lipid profile, except for triglycerides, which declined (P < 0.05). This educational program was successfully incorporated into the regular activities of the El Guarco-area health centers. The primary-care level is ideal for carrying out educational programs for diabetes treatment and early detection that are directed at patients, their families, and health care providers.

A methodology was designed to analyze diet compliance adherence in a group of patients with non-insulin-dependent diabetes mellitus (NIDDM). Nineteen patients were included in the project on Education in Diabetes at in the Community, participating for a period of six months in educational sessions in relation to clinical and nutritional treatment of NIDDM; this methodology allows to analysis of diet compliance with the prescribed specifications. With this objetive, goals were established for the diabetic treatment to be used for the observation of diet compliance in comparison to the real intake of the different nutrients under evaluation, before, during and after the educational intervention. A classification to determine the level of dieting adherence was estaldished, which included the following categories: good, moderate, and bad. At the end of the process, compliance with the energetic recommendations such as carbohydrates, total fat, and cholesterol was considered «good compliance» ; saturated fat, and fiber were placed in the «moderate» category, the effect of these variations was reflected in diet composition. In conclusion, the methodology designed is effective for determining the level of diet compliance in patients with NIDDM, and permits visualizatian of the positive changes in nourishment and clinical evolution in diabetic patients.

This article reports the findings of a nontraditional educational intervention program on the modification of dietary practices in Diabetes Mellitus Type II patients in an urban community in Costa Rica. The educational program consisted of 18 sessios, each one of a duration of two hours, using participate methods as demostrations, visits, sociodramas, mimic, discussion of groups and role playing. The topics were developed by a multidisciplinary team and included general aspects of the illness as well as self control and daily dietary practices. All the sessions were conducted in groups. A written diet was not distributed to particpants, so that modifications would be implimented throuhout the duration of the intervention. The study population consisted of 36 adults, diabetics type II, without chronics complications of the illness. They were divided into two groups: in the experimental group 19 diabetics received the educational intervention and in the control group, 17 which did not receive the intervention. Diet was evaluate in both groups at the beginning and the end of the educational program usign the food record and frequency of intake of foods. The following are the primary findings: The diet was adequate in respect to energy intake in both grups. At hte end of eighth month, diet in the experimental group had significantly decreased in the amount of total and saturated fats, energy and cholesterol. We observed, moreover, the change in the type of fats used for cooking. The experimental group, had un decreased of 10% of the daily intake of palm oil and increased the use of unsaturales oil by13%, which was contrary to the control group. In the same group simple sugar decreased 30% to 10%, while in the control group this increased 5% at the end of the educational process. Eating schedules, the duration between meals and the variability of foods, were reorganized. The recipes were modified by the participants, we observed change in the foods using. Because of this, the experimental group lost more weight than the control group, glicemic levels were normalized and glycoside Hemoglobin reached at desirable values. The lipis (choleterol, Triglycerides, HDL, LDL) were within and acceptable range.