ffect of Nutritional Counseling on the Blood Glucose and Nutritional Knowledge of Diabetic Subjects HEMRAJ B. CHANDALIA ANDJAYSHREE BAGRODIA
The nutritional knowledge and control of diabetes was assessed in 43 nonketosis-prone diabetic subjects. Patients were semiliterate or illiterate. They were exposed to a 1-h nutritional counseling program in groups of three to five. The nutritional counseling program was highly simplified and emphasized only a few important aspects of diabetic diet. Patients' nutritional knowledge improved significantly after nutritional counseling. The control of diabetes also improved significantly in those patients in whom control had been inadequate, DIABETES CARE 2.- 353-356, JULY-AUGUST 1979.
iet is a fundamental element of treatment in diabetes, yet ineffective diet therapy is the most important factor responsible for poor control of diabetes. An elaborate and systematic nutritional counseling program, where the patient and the diet counselor are well motivated, holds promise of success. In developing countries, however, personnel resources are scarce, and the load of clinical work is very heavy in public hospitals and clinics. Furthermore, the patients attending these clinics are often illiterate or semiliterate. Under such circumstances, the feasibility and effectiveness of a nutritional counseling program is seriously questioned by most clinicians. We report the effect of a simple nutritional counseling program on the blood glucose and nutritional knowledge of our clinic patients.
PATIENTS AND METHODS
Patients. 43 nonketosis-prone diabetic patients (12 male, 31 female), aged 25-65 yr, from the Diabetes Clinic of Grant Medical College and J. J. Government Hospital were studied. Of 43 patients, 31 were on oral antidiabetic agents, 9 were on insulin, and 3 were on placebo. 21 patients were overweight (20% above the ideal body weight). All the patients belonged to low income groups. 20 patients were illiterate, and 23 had completed primary or middle school. Methods. Oral antidiabetic drug or insulin dosage were left unaltered during the entire study period. Fasting and 2-h
post-lunch blood glucose (Somogyi-Nelson method) was estimated at control period ( - 1 and 0 wk) and test period (1 and 4 wk). At 0 wk, after the blood glucoses had been drawn, patients were exposed to the nutritional counseling program. Nutritional counseling program. The instructions were imparted in Hindi (Indian language, intelligible to all patients) by postgraduate students of nutrition. Patients were instructed in groups of three to five for 1 h. The discussion covered the following aspects of diabetic diet: (a) All patients were advised to avoid concentrated carbohydrates (sugar and sweets). (b) Patients were advised to exercise an overall control over the total amount of food eaten daily. Relationship of total food eaten, physical activity, and weight trend was pointed out without any scientific discussion of the term calorie. Patients with normal and stable body weight were asked to continue the present total food intake. Overweight patients were asked to reduce fat intake to the minimum possible and reduce cereal intake at main meals by about 25%. (c) Patients were advised to divide their food intake into breakfast, lunch, midafternoon snack, dinner, and bedtime snack. (d) Patients were instructed on the exchangeability of common food items by using the exchange system of diabetic diet. Only four to five common food items under each exchange group were discussed and demonstrated by using common household measurements.
DIABETES CARE, VOL. 2 NO. 4, JULY-AUGUST 1979
EFFECT OF NUTRITIONAL COUNSELING/H. B. CHANDALIA AND J. BAGRODIA
GROUP I GROUP I I FASTING BLOOD GLUCOSE (MEAN*- SO) mg/dl
The fasting and postprandial blood glucose did not alter significantly (t test for paired data) in group I during the control period or after the nutritional counseling. The fasting and postprandial blood glucose of group U did not change significantly during the control period but was significantly (P < 0.001) less at the 1st and 4th wk as compared with the value at 0 wk. Effect of nutritional counseling on nutritional knowledge
P0ST-PRANDIAL BLOOD GLUCOSE