This thesis investigated novel approaches to the delivery of lifestyle education for people with diabetes. The principles of dietary advice for diabetes recommend a high carbohydrate intake, yet carbohydrate foods raise blood glucose levels significantly.
Study 1 was designed as a randomised controlled trial to evaluate the effect of a low carbohydrate (LC) and low fat (LF) diet on glycaemic control and body weight in 26 subjects. Weight loss was greater in the LC group (-6.9kg v -2.1kg, p=0.003). Glycaemic control improved in both groups with a reduction in Alc in both LC and LF groups (-0.3% v -0.2%, p=0.582). There were no significant changes in cardiovascular risk assessed by lipid levels and blood pressure.
Study 2 was designed as a randomised controlled trial to assess a novel education programme delivered by video for 42 people newly diagnosed with Type 2 diabetes. At six months follow-up, there was a significant increase in knowledge in the video intervention group (p=<O.OOOI). There were reductions in A1c (-0.7% v -0.6%, p=0.843), total cholesterol (-0.5mmo1l1 v -0.2mmolll, p=0.347) and LDL cholesterol (-0.5mmo/1 v 0.2mmolll, p=O.l), and physical activity increased in the intervention
group. There were no changes in the control group, but these differences failed to reach between group significance.
Study 3 was an intervention study examining structured education in 51 people with Type 1 diabetes. At one year's follow-up, there was a significant improvement in Ale levels (-0.3%, p=0.03) with no increase in body weight or hypoglycaemia. Diabetes related distress improved significantly at six months follow-up and this was maintained at one year (p=O.O 19).
These studies indicate that both education and modification of carbohydrate intake have a positive effect on outcomes in people with diabetes. People with Type 2 diabetes show increased knowledge after video education, and can achieve significant weight loss by adopting a low carbohydrate diet. People with long-standing Type 1 diabetes can significantly improve glycaemic control and quality of life by adopting a strategy of carbohydrate counting and insulin adjustment.
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