부산대학교 도서관

The ability to identify carbohydrate foods is an important for diabetes self-management for adults with type 2 diabetes (T2D). Until recently, diabetes education for patients with T2D mainly emphasized the fat content of foods. To assess whether T2D patients can identify carbohydrate foods (carbs), we evaluated 56 type 2 patients (age 62±13 yrs, duration 13±11 yrs, BMI 32.5±7.3, A1C 7.7±1.6%, education 15±2 yrs, 45% females). Subjects completed surveys on diabetes distress (Problem Areas in Diabetes, PAID), self-care (Self-Care inventory, SCI-R), and frustration with self-care (Self-Care Problem Areas, SPA) and identified foods containing carbs from a group of 12 food models. 55% of subjects identified at least 9/12 carbs correctly. Carb knowledge scores were correlated with frequency of self-care behaviors (r=0.32, p<0.05), specifically dietary (r=0.41, p<0.01) and general health behaviors (r=0.28, p<0.05) but not with A1C, distress, or frustration with self-care. A1C was correlated with frustration with self-care (r=0.42, p=0.001), duration (r=0.31,p<0.05), and glucose monitoring (r=0.32, p=0.02), and inversely related to frequency of following physical activity recommendations (r=-0.26, p=0.05). Of the 28 subjects with A1C≤7%, 40% take insulin, 71% reported understanding carbs, yet 11 (39%) could not correctly identify carbs. Of those with A1C>7% (n=28), 71% take insulin (p=0.02), 59% reported understanding carbs (p=ns), and 14 (50%) could not correctly identify carbs (p=ns). Among those who correctly identified carbs (>9/12), those with A1C>7 had greater frustration with treatment (38 vs 23, p<0.05) higher BMI's (36 vs 28, p<0.01), and longer duration (16 vs 9, p=0.08) than those with A1C<7%. For those with low carb knowledge, only a trend for frequency of following physical activity recommendations (41 vs 65, p=0.07) differentiated glycemic control groups (A1C>7 vs A1C≤7%). Conclusions: Our data suggest that many patients with T2D do not have working knowledge of carbohydrates. Type 2 diabetes is a progressive disease, as beta cell loss increases with duration and as insulin resistance impedes attainment of glycemic targets, working knowledge of carbohydrates is particularly important for reaching goals. Thus, nutrition counseling for patients with T2D should begin early in the course of the treatment and should emphasize the carbohydrates along with fats and other nutrition concepts. [ABSTRACT FROM AUTHOR]