Thesis (Ph.D)


Dietary advice for people with diabetes: the role of carbohydrate in dietary treatment and an assessment of video education

Abstract

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.

Attached files

Authors

Dyson, P

Dates

Year: 2010


© Dyson, P
Published by Oxford Brookes University
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