Discovering successful strategies for diabetic self-management: a qualitative comparative study.

OBJECTIVE: This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management. RESEARCH DESIGN AND METHODS: Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C <7.0%), fair (7.0%8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups. RESULTS: Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose. CONCLUSIONS: Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control.

Neighborhood Deprivation is associated with lower levels of serum carotenoids among adults participating in the Third National Health and Nutrition Examination Survey.

OBJECTIVE: This study tested the hypothesis that neighborhood deprivation will be associated with lower levels of serum carotenoids in comparison with wealthy residential areas. DESIGN: Cross-sectional, nationally representative survey data were used to assess the relationship between neighborhood level socioeconomic status and serum carotenoids. SUBJECTS: Seventeen thousand two participants aged 17 years and older from the Third National Health and Nutrition Examination Survey were linked with 1990 census data. MAIN OUTCOME MEASURES: Serum levels of lycopene, beta-carotene, alpha-carotene, lutein/zeaxanthin, and beta-cryptoxanthin. STATISTICAL ANALYSIS: Multivariate linear regression was used to model the association of serum carotenoids and neighborhood deprivation, which is a summary index of 11 indicators for tract level socioeconomic status. Adjustments are made for individual level age, sex, years of education, household income, employment, race/ethnicity, body mass index, serum cotinine, alcohol use, physical activity, and serum cholesterol. RESULTS: Multivariate analysis revealed a negative and statistically significant association between high levels of neighborhood deprivation and beta-carotene (beta=-2.98 microg/dL [-0.06 micromol/L], P=0.00), alpha-carotene (beta=-1.28 microg/dL [-0.02 micromol/L], P=<0.0001), lutein/zeaxanthin (-1.69 microg/dL [-0.03 micromol/L], P=0.00, beta-cryptoxanthin (beta=-1.34 microg/dL [-0.02 micromol/L], P<0.0001), and total carotenoids (beta=-8.20 microg/dL, P=<0.0001). Lycopene was not related to neighborhood deprivation. Adjusted mean levels of carotenoids for high deprivation neighborhoods were lower than neighborhoods with low deprivation: beta-carotene=8.72 microg/dL [0.16 micromol/L] vs 20.64 microg/dL [0.38 micromol/L], alpha-carotene=0.44 microg/dL [0.008 micromol/L] vs 5.56 microg/dL [0.10 micromol/L], lutein/zeaxanthin=13.79 microg/dL [0.24 micromol/L] vs 20.55 microg/dL [0.36 micromol/L], beta-cryptoxanthin=4.57 microg/dL [0.08 micromol/L] vs 9.93 microg/dL [0.18 micromol/L], lycopene=22.07 microg/dL [0.41 micromol/L] vs 25.63 microg/dL [0.48 micromol/L], and total=49.56 microg/dL vs 82.36 microg/dL. CONCLUSIONS: Neighborhood deprivation was associated with lower serum levels of carotenoids. There was a substantial disparity between low deprivation and high deprivation residential areas with respect to fruit and vegetable intake.

Pilot using World Wide Web to prevent diabetes in adolescents.

This pilot study tested the effects of an interactive nutrition education Web site on fruit, vegetable, and fat consumption in minority adolescents genetically at risk for Type 2 diabetes. A one-group nonexperimental pretest, posttest focus group design was used. Twenty-one sixth-grade to eighth-grade junior high adolescents who were minorities volunteered to participate. Participants received 5 hours of Web-based nutrition education over 3 weeks. A significant difference in fat consumption was supported from the computerized dietary assessment. No difference was found in fruit or vegetable consumption. Comparative data indicated a rise in body mass index (BMI) percentile from 88.03 (1999) to 88.40 (2002; boys) and 88.25 (1999) to 91.2 (2002; girls). Focus group responses supported the satisfaction of adolescents in the study with the use of the Web-based intervention for nutrition education. Healthy eating interventions using Web-based nutrition education should be further investigated with adolescents.