Hello Fellow Health Professionals,
Welcome to our first professional publication!
In 2018, the estimated statistics for type 2 diabetes currently sit around 500 million globally. For prediabetes, 2017 statistics estimate the rate of ‘impaired glucose tolerance’ to be 7.3% of the global population, with an anticipated increase to 8.3% by 2045. Based on previous estimates, these rates will likely be higher.
While these are very sobering statistics, the good news is that at an individual level we can do a lot to help people with type 2 diabetes and prediabetes treat their condition.
The goal of this monthly publication is to share the outcomes of research so that more evidence can be used in practice. Since DMP have had the honor of helping thousands of people with type 2 diabetes and prediabetes achieve and sustain improved glycemic control with dietary change alone, we intend to share practical ways you might use our experiences to inspire success in your healthcare settings.
Within each professional publication we will share:
- some of our experience
- interesting research and findings
- topical evidence and discussions
- additional resources that you may find helpful
Since I am also doing a PhD that I am incredibly passionate about, I will share updates about the project progression, which I hope you will find insightful.
If you have ideas or requests for this monthly publication, please contact us and let us know – we welcome your input.
I would also appreciate if you could help spread the word. Please share our professional publication with others so we can engage more health professionals and make a difference, together.
Thank you and enjoy.
Founder, Diabetes Meal Plans
Nutritionist (MNutr), Social Scientist (BSocSc)
PhD (Diabetes Nutrition) – currently in progress
Empowering People with Type 2 Diabetes with 'Quick Wins'
Helping people with type 2 diabetes (or prediabetes) achieve ‘quick wins’ is a great way to empower them and enhance motivation.
Let’s look at 2 scenarios to illustrate this in practice.
Scenario 1: Imagine one person with type 2 diabetes is newly diagnosed and they are given information (education) that helps them make practical, immediate changes to their diet and understand the relationship between their blood glucose levels and the food they eat so they can make alterations themselves.
Scenario 2: Consider another situation: imagine a person with type 2 diabetes is newly diagnosed and they are given generic information that they need to eat a healthy diet and exercise.
The difference between the two is scenario 1 shows people how to achieve change while scenario 2 only tells people what to do. There is a big difference in how these two will empower or motivate someone with type 2 diabetes.
The person in scenario 1 will obtain an instant benefit, they will see their blood sugar levels reduce immediately and understand why this happens. As you can imagine, this is very empowering and motivating. The person will feel like they have some control in influencing the outcome and they will feel motivated to do it.
On the other hand, the person in scenario 2 will struggle to get results because they don’t understand the relationship between blood sugar and food, nor do they really understand what a healthy diet is for a person with type 2 diabetes.
Results from our feedback surveys suggest people feel that many health programs and the advice they receive from health practitioners say ‘do this,’ but fail to show them how. This has also been demonstrated in scientific literature.
In one qualitative study, “many participants report lack of interest or expertise in healthcare staff, and an increasing sense of a “tick box” culture. Participants had experience of poor quality information that was difficult to understand and not relevant to their personal needs.”
In another qualitative study, people “indicated that lack of adequate information undermined effective diabetes self-management and resulted in confusion when patients attempted to make day-to-day decisions about diet and medications.”
The ‘how’ is what people really need and you can help bridge this barrier by showing people how.
Show People HOW: Here’s what you can do as a healthcare practitioner
We believe it’s important to enable people with the practical tools they need to succeed in changing their health. We believe people are motivated to make diet and lifestyle changes but they need and want to understand ‘HOW.’ Our experience shows that when we do show people how, the results can be tremendous and the short and long term motivation is obtained and sustained.
Here are a couple of suggestions to help you achieve this change in the people you work with.
How to get ‘quick wins’ with diet and blood sugar
It is well demonstrated in scientific literature that carbohydrate restriction produces the most immediate reductions in blood sugar levels. The 2019 American Diabetes Association dietary guidelines also agree with this evidence.
Carbohydrates are the single biggest nutrient that influences blood sugar levels, so educating people about this is critical. Although carbohydrates refers to a wide variety of foods and can be a complex topic, educating people about carbohydrate restriction is initially very easy.
Advise your patients to:
- Reduce or eliminate the high carb foods – bread, pasta, rice, potatoes (including sweet potatoes), noodles, and flour-based products.
- Increase intake of vegetables, especially above the ground veggies
- Focus on whole foods over processed foods
- Not worry too much about calories and ‘how much’ of everything to eat because if they do the above 3 things, the rest will fall into place
Doing the above will provide people with immediate benefits with blood sugar levels. Our experience shows that within 7 days people will see patterns of blood glucose lowering, and over a 21 day period our surveys show:
- 85% of people lower post-meal blood sugar levels
- 34% of people lower fasting blood sugar levels
The relationship between blood sugar levels and food
Daily blood glucose monitoring can help a person understand how food influences their blood sugar levels. Although daily monitoring is not necessarily prescribed by doctors, it is highly recommended as a self-management strategy, even for those people with type 2 diabetes who are not insulin dependent, and those who are prediabetic, too.
The general recommendation for monitoring is one to two times per day, fasting and after the largest meal of the day. An additional monitoring method is to teach people how to monitor in pairs, especially if people wish to understand how their blood glucose measurement relates to food.
Here’s simple instructions to provide people:
Monitoring in pairs
Step 1: Take your blood sugar level before a meal. Write it down.
Step 2: Eat your meal, setting your timer for 2-hours from your first bite of food.
Step 3: Take your blood sugar level 2-hours after your meal. Write it down.
Step 4: Evaluate your readings. Are they within the healthy range? Or could you make some adjustments to improve these readings?
Step 5: So you can get a sense of how monitoring in pairs can help you compare foods and how they influence your blood sugar levels, let’s do a breakfast or lunch experiment.
A testing experiment:
For breakfast one morning, have your usual breakfast – such as oatmeal, toast, bagels or cereals. Or your usual lunch – a sandwich, pie, pasta and so forth. Follow steps 1-3, noting down your blood sugar levels before the meal and 2-hours after the meal.
The next day for breakfast or lunch, pick an egg-based breakfast or a lunch from our meal plans or recipe database. Follow steps 1-3, noting down your blood sugar levels before the meal and 2-hours after the meal.
Evaluate and compare the results. Did day 1 with levels show as higher than day 2?
You will most likely answer yes. The reason for this is the carbohydrate content of the 2 meals. Carbohydrates are the nutrient that has the greatest impact on blood sugar and A1c levels, so on day 2 you reduced the carb content of the meal and got a lower result.
Monitoring in pairs is a very useful way to compare foods, especially carbs, and see how they influence your blood sugar levels. You can then use that information to make different choices and alter your diet to get better results.
*We are working on some patient handouts for our next publication.
Got an idea for a great patient handout that you’d find particularly useful? Please contact us and let us know – we welcome your input.
PhD Project Update
DMPs Founder, Jedha Dening, is currently doing a PhD in type 2 diabetes nutrition. Each month we will provide an update on how the project is progressing.
The title of the project is: Effectiveness of an Internet-Based Low Carbohydrate Diet in People with Type 2 Diabetes
Systematic Review (almost complete)
The title of this paper is: Web-based interventions for dietary behavior change in people with type 2 diabetes
*We are now in the editing stage, getting it ready for submission to a journal.
We know that diet is critically important to improving glycemic control in people with T2D, however, it is quite surprising there are only 5 web-based interventions that are either solely focused on dietary behavior change or have used any type of dietary assessment. There are a few other digital interventions that evaluate dietary behavior, for instance, smartphone apps and telehealth – though this data is again limited. And there are also several other digital interventions that look at overall self-management. Since this PhD project focus is on diet, we are specifically looking at ways we can enhance or improve dietary behavior to improve glycemic control.
Overall, the web-based interventions show great potential for improving dietary behavior, as 4 of the 5 studies show statistically significant outcomes for dietary behavior change for 4-12 month follow up periods. It is difficult to compare study outcomes because they all use different dietary assessment measures. Still, these findings are promising and support the development of more web-based interventions.
In terms of improved glycemic control measured by A1c, two studies show statistically significant outcomes, while another shows statistically significant within-group changes with trending reductions over a 12 month follow up period. Therefore, we do need more data to demonstrate their effectiveness for improving glycemic control.
PhD Project Plan
The PhD project will be a series of papers that represent the study progress. We are still refining the overall project plan, but at this time it stands as follows:
Planned study/publication: The design and development of a user-centred low carb diet website for people with type 2 diabetes.
From previous research, we will aim to identify key intervention components and design and develop an intervention by engaging with a user-panel of people with T2D.
*We know an internet-based low carb diet for people with T2D works in practice because this is exactly what we do here at DMP, however, there is no current scientific evidence that supports this.
Planned study/publication: Optimization of an internet-based low carb diet intervention in people with type 2 diabetes.
While a Randomized Controlled Trial (RCT) is considered the gold standard for determining effectiveness of a treatment (intervention) compared to a control (alternative), an RCT evaluates an intervention package as a whole, it can’t evaluate the effectiveness of individual intervention components to understand whether they impact the outcome variable (for instance, whether a component produces a reduction in A1c). An RCT also can’t truly determine the interaction effects of those intervention components upon one another.
Currently in digital health interventions this presents significant barriers to moving our knowledge forward as we don’t understand many things. For instance, what factors within an intervention influence adherence and engagement and how to improve these factors.
Therefore, we will be using new methodologies and intervention designs to help us not only evaluate the effectiveness in achieving dietary behavior change and improved glycemic control, but also to unpack and understand components that produce significant effects in digital health interventions. Thankfully, digital interventions provide us with methods we can do this more efficiently than normal interventions can.
Planned study/publication: Mixed methods process evaluation of an internet-based low carb diet intervention in people with type 2 diabetes.
We will evaluate data captured from website usage patterns, website downloads, user login patterns etc, and also gather qualitative data from participant interviews so that we can explain some of the quantitative data we gather and also understand success factors and barriers that lead to, or prevent intervention effectiveness.
So in addition to measuring the effectiveness of dietary behaviour change and glycemic control and active components, we can also look at the intervention in much more detail, especially from the participants perspective.
Advancing behavioral change research
These studies will be very valuable to the field of behavioral intervention science.
There is ample evidence that low carb diets work in non-internet-based settings but at this stage there is only one small online pilot study using a keto diet. We will be using low carb, not keto – there is a difference.
DMP already implements a low carb diet via the internet in practice, and we know it works very well, you only have to read our many testimonials to see this. But we need more scientific data about this to inform health practitioners, organizations, and key stakeholders so that we can make a difference in more people’s lives.
We also need more data that drills down into intervention components, especially those that are delivered via the web, because the web offers incredible potential to support diabetes education and the healthcare system in a cost effective way.
One other very important contribution will be to highlight the usefulness of ‘new’ modern methodologies and intervention designs. These have the capacity to deliver more useful data and they also have something else very unique – the ability to iterate.
This means instead of building an entirely new intervention (something that happens a lot with RCTs, many getting shelved, which equals loss of time and resources), we can rework the same intervention if necessary. We can also build on an intervention. For instance, we could have dietary programs running publicly while at the same testing a new set of participants with new features of the intervention. This is very powerful because it allows us to build a cumulative knowledge base for future research. Plus, is saves a tremendous amount of resources in terms of costs and time, and also produces interventions that are highly scalable.
And that’s exactly what we need if we are going to change the face of diabetes given the scale that we are seeing diagnosis worldwide!
Thank you for browsing our first professional publication.
As health professionals it’s so important to stay up-to-date with research, but since we’re all so busy it can also be difficult to find time to do. Therefore, this monthly publication will be a valuable resource that you can browse through to help your patients achieve better results.
If you have ideas or requests for this monthly publication, please contact us and let us know – we welcome your input.
Founder, Diabetes Meal Plans
P.S. Please share our professional publication with others so we can engage more health professionals and make a difference, together.