成人糖尿病管理营养治疗建议

<正>饮食模式●各种饮食模式(不同食物或食物类型的联合)均可用于糖尿病营养管理。推荐饮食模式时需要考虑患者的个体偏好(如传统、文化、宗教、健康信念和目标、经济状况等)和代谢目标。(E)饮食模式常用于描述不同食物或食物类别的联合,其特征是在营养与促进健康和疾病预防之间起联接作用。人们日常食用各种食物,而不是单一营养素,因此研究饮食与疾病的相关性具有重要的价值。影响饮食模式的因素包括但不限于健康食物的获取、传统惯例、饮食文化系统、健康信念、对健康或疾病有益的食物的基本知识、购买健康食物的经济条件和经费来源等。     

临沧市社区糖尿病患者对疾病认知及健康教育需求状况调查分析

目的研究调查社区糖尿病患者对疾病认知及健康教育需求状况。方法回顾性分析2016年临沧市某社区管理的糖尿病患者184例,所有患者均采取问卷调查形式对糖尿病相关知识及健康教育内容作调查,重点分析当前社区糖尿病患者对糖尿病基础知识、自我护理知识需求,评估患者对疾病认知状况,了解患者健康知识的获取途径,探析患者对健康教育方式的期望。结果糖尿病患者对血糖的控制以及对病症预后改善知识需求最为迫切,同时对于糖尿病的治疗方法、疗效以及相关并发症的预防与处理等知识需求也超过90%以上;患者对于相关疾病健康知识的获取途径多来自于医护工作者的讲解,占总比85.87%(158/184);对于健康教育方式多期望获得医护工作者的个体化宣教指导。结论社区糖尿病患者的健康教育应针对患者健康知识的教育需求关注点进行详细讲解,提高患者自身以及家属对糖尿病的正确认知能力,提升患者自我管理,正确认识糖尿病的治疗,改善生活质量。     

糖尿病的营养治疗

糖尿病的营养治疗杜寿玢营养治疗在所有糖尿病患者的治疗与管理上是必要的，无论是Ⅰ型或Ⅱ型的糖尿病病人，无论是注射胰岛素或口服降糖药，均须坚持营养疗法。部分轻型病例，单纯控制饮食即可奏效。饮食、运动、药物三者的科学结合，再加上患者掌握糖尿病知识，均是糖尿...     

老年慢性肾脏病合并糖尿病的营养治疗

营养治疗是慢性肾脏病（chronic kidney disease, CKD）治疗的重要组成部分，合并糖尿病的老年CKD的营养治 疗存在着特殊性。低蛋白饮食作为营养治疗的核心，可以改善合并糖尿病的老年CKD患者的预后，但同时引发营养 不良、血糖升高、心情低落的风险较年轻患者更高，因此适度的低蛋白饮食和及时的营养状态评估对于此类人群尤为 重要，同时应提高老年患者饮食治疗的依从性从而保障低蛋白饮食的实施。需要特别注意的是合并糖尿病的老年 CKD患者也常伴有心脑血管疾病等其他合并症，应该结合患者的营养状况，综合考虑制定个体化营养方案。     

糖尿病患者的中医饮食护理相关问题分析

目的对糖尿病患者的中医饮食护理方法和措施、相关问题进行探讨分析。方法选取该院于2014年5月—2016年3月收治的92例糖尿病患者作为研究对象,对其临床资料进行回顾性分析,并以专科护理人员共24人为研究对象,结合问卷调查的形式掌握糖尿病中医饮食护理现状及存在的问题,并对饮食护理的方法和措施进行探讨。结果糖尿病患者的中医饮食护理工作仍存在较多问题,如患者对自身疾病和中医饮食护理的认识程度不高,且无法长时间坚持护理治疗,护理人员则存在专业素质不高的问题,中医饮食护理方案同样存在较大欠缺等。结论糖尿病患者中医饮食护理工作的开展应依据患者的具体病情和护理需求,以个体化护理和个性化的饮食治疗方案配合临床治疗,进一步提高护理人员的专业素质能力,为中医临床治疗效果的提升提供重要保证。     

3招饮食技巧保护肾功能

糖尿病肾病患者通过合理饮食,可防止微量白蛋白尿发展为大量白蛋白尿,保护肾功能,延迟肾脏损害的进展以及相关的继发性疾病,如高血压、血脂异常、尿毒症等,相反,不健康的饮食会对肾功能造成负担.营养摄入与生理负荷之间的平衡非常重要,对很多糖尿病肾病患者来说也挺难操作.     

饮食营养知识-态度-行为(K-A-P)的研究

采用知识-态度-行为(K-A-P)的模式对糖尿病患者的营养知识水平、营养态度以及饮食营养行为等三方面进行问卷调查.结果大部分患者的营养知识缺乏,尤其文化程度低的得分(K值)(x2=21.965,P＜0.01),未接受教育者(t=-6.071,P＜0.01);但大多数糖尿病患者营养态度较积极(A值),希望获得饮食营养知识;大多数存在许多不良的饮食行为(P值),如常多食、喜吃零食及油炸熏烤食品、进食速度快、嗜好烟酒等,K值与P值存在一定的相关性(r=0.245,P＜0.01);多元逐步回归分析显示文化程度和有无接受糖尿病教育的经历是影响饮食营养KAP评分水平的最主要的因素(P＜0.01)结论知识-态度-行为(K-A-P)的研究是有效评估糖尿病患者糖尿病饮食营养认知状态的一种方法,在糖尿病控制中有重要作用.     

雅培糖尿病医疗营养新品在中国上市

作为全球医用营养品领域的领导者,雅培公司日前正式宣布在中国上市全球糖尿病营养品的领先品牌——伊力佳。此次新产品上市,意味着雅培在中国推出首个完整的糖尿病营养方案。全新上市的伊力佳（混悬剂）和已上市的雅培益力佳SR营养配方粉（粉剂）,可帮助糖尿病患者平稳血糖,提供全面均衡的营养,满足不同患者不同病情条件下的营养需求。     

2013年美国糖尿病学会《成人糖尿病患者管理的营养治疗建议》解读

健康饮食、规律锻炼以及合理药物治疗是糖尿病整体管理的最关键部分,而对于广大糖尿病专科医生来讲,饮食治疗却是整个方案中最难循证的部分.美国糖尿病学会（ADA）自1974年全球首次提出“糖尿病患者营养与饮食推荐原则”,并随着循证证据的不断完善定期更新推荐内容.21世纪以来,2004年、2008年均推出更新的“营养治疗建议”（简称“建议”）,ADA已逐渐将营养治疗定位于糖尿病整体管理中不可或缺的部分,要求每个糖尿病患者应积极参与到个体化饮食管理中¨].然而美国一项纳入了18 404例糖尿病患者的调查数据表明,9年里只有9.1％的患者曾经接受过一次及以上的注册营养师的个体化营养指导[2].许多患者及医疗机构均未意识到应提供营养咨询或治疗服务.因此,2013年这份基于循证基础的营养推荐“建议”[3]为各种医疗机构的医务人员提供了实用性依据.     

食管癌患者营养知识需求调查与护理对策

目的 调查食管癌患者对营养知识的需求，探讨行之有效的护理对策。方法 采用问卷方式，对200例食管癌住院患者营养知识需求进行调查。结果 几乎100％食管癌患者希望医务人员讲解、病友经验介绍营养知识，96％食管癌患者希望医务人员进行饮食指导、讲解饮食与疾病的相互关系、减轻治疗不良反应3个方面。结论 加强健康教育力度，重视食管癌患者营养知识需求，做好营养护理工作。     

OASIS: A Community-based Model for Successful Aging

OASIS, a national non-profit organization founded in 1982, is dedicated to enriching the lives of people age 50 and older by offering programs that stimulate the intellect, promote healthy and active lifestyles and encourage community service. The OASIS vision is for older adults across the United States to have opportunities to pursue vibrant, healthy, productive and meaningful lives. OASIS seeks to positively impact the older adults’ lives—by partnering with other organizations to share knowledge; offer evidence-based programs; conduct evaluations; and adapt to meet the needs of diverse audiences. Today, nearly 40,000 people participate at any one time in OASIS programs, with more than 6,700 volunteers providing over 488,000 hours of service each year. Approximately 370,000 adults are members of OASIS in 39 cities across the country. This number is expected to increase dramatically with the aging of the United States population. It is estimated that, between the years 2000 and 2030, the number of older adults will grow from 35 million to 72 million.     

Gestational diabetes mellitus: Non-insulin management

Gestational diabetes mellitus (GDM) complicates a substantial number of pregnancies. There is consensus that in patients of GDM, excellent blood glucose control, with diet and, when necessary, oral hypoglycemics and insulin results in improved perinatal outcomes, and appreciably reduces the probability of serious neonatal morbidity compared with routine prenatal care. Goals of metabolic management of a pregnancy complicated with GDM have to balance the needs of a healthy pregnancy with the requirements to control glucose level. Medical nutrition therapy is the cornerstone of therapy for women with GDM. Surveillance with daily self-monitoring of blood glucose has been found to help guide management in a much better way than blood glucose checking in labs and clinics, which tends to be less frequent. Historically, insulin has been the therapeutic agent of choice for controlling hyperglycemia in pregnant women. However, difficulty in medication administration with multiple daily injections, potential for hypoglycemia, and increase in appetite and weight make this therapeutic option cumbersome for many pregnant patients. Use of oral hypogycemic agents (OHAs) in pregnancy has opened new vistas for GDM management. At present, there is a growing acceptance of glyburide (glibenclamide) use as the primary therapy for GDM. Glyburide and metformin have been found to be safe, effective and economical for the treatment of gestational diabetes. Insulin, however, still has an important role to play in GDM. GDM is a window of opportunity, which needs to be seized, for prevention of diabetes in future life. Goal of our educational programs should be not only to improve pregnancy outcomes but also to promote healthy lifestyle changes for the mother that will last long after delivery. Team effort on part of obstetricians and endocrinologists is required to make "the diabetes capital of the world" into "the diabetes care capital of the world".     

Dietary prescription in diabetes mellitus

No one specific diet is recommended by the ADA for the management of diabetes. The prescribed diet should be based on nutritional assessment, treatment goals, and desired outcome. The nutritional therapy should be individualized to meet the patient's nutritional requirements. Glycemic control should be maintained by monitoring metabolic parameters, adjusting medication, and patient education.     

Ocular telehealth initiatives in diabetic retinopathy

Diabetic retinopathy (DR) is a common complication of diabetes mellitus and a leading cause of new-onset vision loss in adults worldwide. Current medical and surgical evidence-based care, including laser photocoagulation, is effective in preserving vision. This care is most effective prior to the onset of ocular or visual symptoms, but many diabetic persons do not receive the recommended annual eye examination for the evaluation of the retina for level of DR. With diabetes incidence and prevalence increasing at epidemic rates and the prediction that 370 million people worldwide will have diabetes by the year 2030, human and fiscal resources will be unable to meet the visual needs with current acute care methods. Appropriate and validated telemedicine programs for DR hold the promise of both enrolling patients into appropriate eye care programs and, more importantly, providing more effective, high-quality diabetes eye care based on current and developing technology.     

Knowledge and awareness about diabetes and periodontal health among Jordanians

The aim of this study is to evaluate the awareness, perception, sources of information, and knowledge of diabetes mellitus and periodontal health among Jordanians, to examine the factors related to their knowledge, and organize effective education programs. A random sample of 500 diabetic patients was recruited from three hospitals and three comprehensive health centers that represent both urban and rural populations in Jordan between September 25, 2006, and February 20, 2007. Completed questionnaires with the answers were returned by 405 participants (response rate was 81%). Only 28% indicated that they followed up gum diseases with the dentist; 48% were aware that diabetic patients are more prone to gum diseases and oral health complications. About a third (38%) recognized that their periodontal health might affect their glycaemic level. Television and Internet were the main source of knowledge for dentists with the rate of 50%. Knowledge about diabetes and periodontal health among diabetic patients is low, and majority of patients were unaware of the oral health complications of their disease and the need for proper preventive care. Issues on education need to be addressed. Therefore, appropriate educational programs should be planned according to community needs, and the target of these programs should be patients with irregular visits to the dentist and physicians. The clinical implication of our findings is that dentists, physicians, and other health providers should inspect diabetic patients for gum diseases each time they come for care and recommend that diabetic patient see a dentist regularly.     

An assessment of self-care knowledge among patients with diabetes mellitus

PurposesThis study aimed to (1) assess the level of diabetes self-care knowledge among patients with diabetes mellitus and (2) examine the relationship between patients' diabetes self-care knowledge and their demographic and medical characteristics.MethodsA cross-sectional design was used to implement the study. A convenience sample of 273 diabetic patients were recruited from five primary health-care centers in Amman- Jordan.ResultsThe overall level of knowledge of diabetes self-care in the total sample was moderate (58.28% (SD = 18.24)). The highest level of knowledge was meal planning (70.2%) followed by monitoring, causes of diabetes, foot care, symptoms and complication, diabetic medication, and the lowest level was exercise (42.5%). Furthermore, knowledge of diabetes self-care was found to be associated with age, educational status, diabetic medications and years with diabetes.Conclusionand Practice implications: The study findings emphasized that diabetic patients had a moderate level of knowledge and there were many of the learning needs for each area of knowledge. The health-care professional has an important role in developing the appropriate diabetes educational programs based on patients' learning needs and patients' characteristics. These programs that enhances knowledge on diabetes could be reduced or prevented diabetes-related complications.     

Structured diabetes self-management education and its association with perceived diabetes knowledge,information, and disease distress: Results of a nationwide population-based study

ObjectiveTo evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress.MethodsWe included 796 ever- and 277 never-DSME participants of the population-based survey “Disease knowledge and information needs - Diabetes mellitus (2017)” from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes.ResultsDSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48–4.33), treatment (2.41; 1.36–4.26), acute complications (1.91; 1.07–3.41) and diabetes in everyday life (1.83; 1.04–3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04–2.18) and acute complications (1.71; 1.71–2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56–8.60) and diabetes care specialists (5.62; 3.61–8.75) as information sources. DSME participation was not associated with disease distress.ConclusionDSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.     

"They care but don't understand": family support of African American women with type 2 diabetes

PURPOSE: This study evaluated the relationship between perceived social support among African American women with type 2 diabetes and diabetes self-management. METHODS: The sample included 12 African American female patients at a diabetes clinic in the southeastern United States. Focus group participants responded to questions related to social support and its influence on diabetes management. RESULTS: Support comes particularly from family, but also friends and/or healthcare providers. The dual challenges of diabetes management and multicaregiving were an expected theme from the sessions. A unique emerging theme, however, was the women's perception of a lack of understanding of their needs by members of their social networks. Participants believed that those who provide support claim they care and try to be helpful but provide minimal physical assistance or emotional understanding of their needs, which could vary daily. Those who provide informational support seem to care but misunderstand the type of information actually needed and how best to deliver it. CONCLUSIONS: Healthcare providers can help improve communication with these women by actively seeking to meet their support needs and educating families so that provisional support is more meaningful and diabetes management more attainable.