Knowledge and attitudes of family physicians about clinical practice guidelines and the care of patients with type 2 diabetes mellitus.

This study examined the attitudes of Louisiana family physicians toward clinical practice guidelines in general and specifically how attitudes and familiarity with the American Diabetes Association Clinical Recommendations (ADACR) correlated with knowledge and evidence-based "best practice" in the care of type 2 diabetes. Surveys were mailed to a random sample of 278 eligible physicians from which a 32% response rate was obtained (n = 90). Family physicians' general attitudes towards guidelines were neutral. Attitude correlated significantly with knowledge of the ADACR (P = .03) but not with "best practice". Despite low scores for knowledge, all but one of the ADACR were adhered to by more than 85% of respondents. Physician attitudes do not appear to be barriers to guideline implementation. Results may be used to focus studies of processes and outcomes in guideline implementation.

Nutrition and the management of type 2 diabetes.

Nutritional recommendations for patients with type 2 diabetes have changed dramatically over the last 60 years. We present a review of the evolution of these recommendations, as well as a comprehensive overview of the current recommendations for specific food components. The general principles of the nutritional management of type 2 diabetes are: (1) Dietary recommendations for patients with diabetes should be similar to those for the general population; (2) Dietary recommendations should be flexible and highly individualized for the patient and his or her family; (3) Table sugar or foods containing sugar do not need to be restricted to a level less than in a typical American diet; (4) Readily digestible starches raise the blood glucose more than sugars; (5) The effects of weight loss on glycemic control will occur within 2 or 3 months, after which more definitive therapies should be instituted; and (6) Patients should not be stigmatized for failing to lose weight, and weight cycling should be discouraged. Nutritional interventions should concentrate on reducing known risk factors for cardiovascular disease and maintaining glycemic control without jeopardizing the quality of life, the health, or the safety of the patient.