Advertisement
Treating Type 2 Diabetes in Youths

Treating Type 2 Diabetes in Youths

The American Diabetes Association recently released nutrition therapy recommendations for the management of diabetes. Published in Diabetes Care, the new statement provides a set of recommendations based on reviews of recent clinical investigations (Table 1). The statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriately portioned sizes as part of an eating plan. These plans must take into account individual preferences, culture, religious beliefs, traditions, and metabolic goals. Nutrition Therapy Is Effective The American Diabetes Association recognizes that nutrition therapy is provided by a variety of health professionals, and published research shows that it is effective when delivered by various health professionals. Studies suggest that nutrition therapy produces A1C reductions similar or greater than what is expected with treatment with currently available pharmacologic treatments for diabetes. “Ideally, patients with diabetes should be referred to registered dietitians (RDs) for diabetes nutrition therapy or participate in diabetes self-management education (DSME) programs that include instruction on nutrition soon after their diagnosis,” says Alison Evert, MS, RD, CDE, who was part of the writing group that developed the position statement. The position statement from the American Diabetes Association highlights guidelines from the Academy of Nutrition and Dietetics that recommend several effective structural components when implementing medical nutrition therapy for adults with diabetes (Table 2). “An important goal of nutrition therapy includes collaborating with healthcare providers to develop individualized eating plans and to encourage people with diabetes to get the ongoing support they need to promote health behavior changes.” Individualizing Approaches The American Diabetes Association recommends that all people with diabetes make nutrition therapy a part...
Practicing What We Preach?

Practicing What We Preach?

It has been largely assumed that healthcare workers (HCWs) take better care of themselves than the patients they treat because they have greater knowledge of appropriate healthcare choices than the general public and because of their position as role models for patients. “HCWs represent an important group in which to study individual health behaviors,” explains Kenneth J. Mukamal, MD, MPH. “Empiric evidence suggests that HCWs who appear to adhere to the advice they give to their patients may have their advice taken more seriously than from HCWs who are less healthy. Unfortunately, little data exist from long-term studies to confirm this association.” In many respects, HCWs represent a best-case scenario for public health research, according to Dr. Mukamal, because of their access to the best health knowledge available. He adds that when physicians are successful in achieving certain health-related goals, it may indicate what accomplishments can be expected in the general public if efforts are made for greater education on that topic. However, he says the pendulum swings both ways, warning that if HCWs are not meeting a certain goal, it suggests that societal pressures may be difficult to overcome. A Deeper Look into Healthcare Worker Lifestyle Dr. Mukamal and Benjamin K. I. Helfand, MSc, had a research letter published in JAMA Internal Medicine that further investigated the healthcare and lifestyle practices of HCWs. The study team used the CDC’s Behavioral Risk Factor Surveillance System, an annual telephone survey of adults in the United States. HCWs were identified as respondents who replied “yes” when questioned if they provided direct patient care as part of their routine work. The authors...
Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...

Tattoos & Piercings: Learning Lessons for Emergency Physicians

Tattoos and piercings were once relegated to specific cultures and societal types but are be­coming increasingly common across all ages and genders throughout the United States. “For emergency physicians (EPs), tattoos and piercings have become important non-verbal clues about someone’s lifestyle,” says Michael S. Urdang, MD, BSc, MBBS, MRCS. “In addition, these body modifications have been identified as the cause of an ED visit more often in recent years.” Considering the large scope of tattoos and pierc­ings among ED patients, EPs must recognize and understand the medical complications that may arise as a result of these body modifications. A deeper understanding of the psychological associ­ations of tattooing and piercings is also important. In addition, EPs should recognize the relevance of body modifications to the current chief complaint when patients present to EDs. In the November 2011 Western Journal of Emergency Medicine, Dr. Urdang and colleagues published a review in which the most common forms of tat­toos and piercings were elucidated. The review also described how these body modifications may have affected the physical and psychological health of patients undergoing treatment. Potential pitfalls in treating complications associated with tattoos and piercings were also described in the review. Increasing Prevalence of Tattoos & Piercings Recent surveys have shown that there has been a significant increase in the prevalence in tattoos within the U.S. In 2006, a North American survey of adults aged 18 to 50 found that 24% had tat­toos and 14% had body piercings (excluding the ear). Those who were tattooed were more likely to be less educated, use recreational drugs more fre­quently, and less likely to show any religious...
[ HIDE/SHOW ]