The role of socio-economic and clinical factors on HbA1c in children and adolescents with type 1 diabetes: an Italian multicentre survey.

OBJECTIVE: To identify the role of the family's socio-economic and clinical characteristics on metabolic control in children and adolescents with type 1 diabetes. METHODS: In this cross-sectional, multicentre study, 768 subjects with type 1 diabetes under 18 years of age were consecutively recruited from January 2008 to February 2009. Target condition was considered for HbA1c values <7.5% (<58 mmol/mol). A multiple correspondence analysis (MCA) was performed to analyze the association between the socio-economic and clinical characteristics of the participants. A logistic regression analysis was performed to identify factors associated with the subjects metabolic control. In both analyses, the family's socio-economic status was represented, measured by the Hollingshead Four-Factor Index of Social Status (SES) or by parental years of education. RESULTS: A total of 28.1% of subjects reached target HbA1c values. The MCA identified a strong association between at-target condition and several factors: high levels of SES or high levels of parental education, the use of the carbohydrate counting system, the use of insulin pumps, the use of the insulin delivery system over a short period of time, a normal body mass index. The logistic regression analysis showed that SES and the mother's years of education were significantly associated with the target condition [odds ratio (OR): 1.01, 95% confidence interval (CI): 1.01-1.03, p = 0.029; OR: 1.05, 95% CI: 1.01-1.10, p = 0.027, respectively). CONCLUSIONS: Personal, clinical, and family characteristics were found to be associated with HbA1c target. Their identification can be crucial in addressing strategies to optimize metabolic control and improve diabetes management.

Perceptions of the Healthfulness of Foods of New Zealand Adults Living With Prediabetes and Type 2 Diabetes: A Pilot Study.

OBJECTIVE: To investigate dietary perceptions of adults with prediabetes and type 2 diabetes. METHODS: Three discussion groups (n = 12) were conducted to investigate how participants source dietary information and evaluate the healthfulness of foods. Participants were men and women with prediabetes or type 2 diabetes. White board notes were photographed and audio recordings transcribed. Codes were applied and themes generated using an inductive approach. RESULTS: Four themes emerged: (1) perception of food components, (2) factors perceived to influence the healthfulness of foods, (3) perceptions of dietary information, and (4) challenges to forming accurate perceptions. Participants perceived the healthfulness of food to be influenced largely by carbohydrates, fat, and sugar. CONCLUSIONS AND IMPLICATIONS: Perception of the healthfulness of food varied among participants and at times was contrary to dietary guidelines. Participants were wary of dietary advice and sought consistent, reliable, and up-to-date sources of information to guide food choices.

Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.

The Cost of a Healthier Diet for Young Children With Type 1 Diabetes Mellitus.

OBJECTIVE: This study used a market-basket approach to examine the availability and cost of a standard food shopping list (R-TFP) vs a healthier food shopping list (H-TFP) in the grocery stores used by a sample of 23 families of young children with type 1 diabetes mellitus (T1DM). METHODS: The researchers used frequency counts to measure availability. The average cost of the R-TFP and H-TFP was compared using paired t test. RESULTS: Small or independent markets had the highest percentage of missing foods (14%), followed by chain supermarkets (3%) and big box stores (2%). There was a significant difference in average cost for the R-TFP vs the H-TFP ($324.71 and $380.07, respectively; P < .001). CONCLUSIONS AND IMPLICATIONS: Families may encounter problems finding healthier foods and/or incur greater costs for healthier foods. Nutrition education programs for T1DM need to teach problem solving to help families overcome these barriers.

Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes.

Little is known about diabetes management among low-income older Americans. This study used statewide self-administered survey and Medicare claims data to examine the relationships of food insecurity and medication (re)fill adherence in a sample of Medicare Part D beneficiaries with type 2 diabetes in need of food assistance in Georgia in 2008 (n = 243, mean age 74.2 ± 7.8 years, 27.2% African American, 77.4% female). (Re)fill adherence to oral hypoglycemics was measured as Proportion of Days Covered. Food insecurity was assessed using a six-item validated standard measure. About 54% of the sample were food insecure. About 28% of the diabetic sample did not (re)fill any diabetes medication and over 80% had at least one diabetes complication. Food insecure participants showed comparable (re)fill adherence to food secure participants. However, 57% of food insecure participants were nonadherent to oral hypoglycemics. Underlying basic needs must be addressed to improve diabetes management in this population.

Biochemical perspectives of xylitol extracted from indigenous agricultural by-product mung bean (Vigna radiata) hulls in a rat model.

BACKGROUND: The production of xylitol from lignocellulosic material is of great interest around the world. It can be used as bulk sweetener and its possible lower energy value has increased acceptance for discerning consumers. Xylitol was produced from indigenous agricultural by-product (mung bean hulls) through Candida tropicalis fermentation. Further, xylitol incorporation at different concentrations (0, 100 and 200 g kg⁻¹) was carried out with the purpose of appraising the suitability and claimed health benefits of this dietetic ingredient in food products. Asserted biochemical perspectives of the xylitol intake were evaluated through biological studies for normal and streptozotocin-induced diabetic rats. RESULTS: The addition of xylitol significantly affected feed intake, weight gain, liver and cecum weight in both normal and diabetic rats. The biochemical profile of serum was improved with xylitol incorporation in the diet. Serum glucose, cholesterol and triglycerides levels were decreased depending on xylitol intake level. CONCLUSION: The results of the present study demonstrated that mung bean hulls have high potential as a new feedstock for xylitol production. In addressing the current concerns of obesity and diabetes, xylitol extracted from such agricultural waste should be considered in diet-based therapies for weight loss programmes.

Prevalence of food insecurity in patients with diabetes in western Kenya.

AIMS: To determine the characteristics of patients with diabetes who reported food insecurity at three diabetes clinics in western Kenya. METHODS: This study includes routinely collected demographic data at the first presentation of patients with diabetes at clinics in western Kenya from 1 January 2006 to 24 September 2011. A validated questionnaire was used to assess food insecurity with descriptive and comparative statistics being used to analyse the food-secure and food-insecure populations. RESULTS: The number of patients presenting to these clinics who were food-secure and those who were food-insecure was 1179 (68.0%) and 554 (32.0%), respectively. Comparative analysis shows a statistically significant difference in weight, BMI, the presence of a caretaker, and use of insulin between the two groups. These variables were lower in the food-insecure group. The overall assessment of the clinic population revealed an abnormally high mean HbA1c concentration of 81 mmol/mol (9.6%). CONCLUSIONS: Despite the widely recognized contribution of caloric over-nutrition to the development of diabetes, this study highlights the high prevalence of food insecurity amongst patients with diabetes in rural, resource-constrained settings. Other factors, such as the lower prevalence of obesity, poor glucose control, challenges in the use of insulin because of the risk of hypoglycaemia, and varying subtypes of diabetes in this population, point to the need for additional research in understanding the aetiology, pathophysiology and optimum management of this condition, as well as understanding the effects of enhancing food security.

Economic analysis of a diabetes-specific nutritional meal replacement for patients with type 2 diabetes.

This study extends nutritional intervention results reported by short-term clinical trials of a diabetes-specific nutritional meal replacement by assessing the ten-year impact of the interventions on patient outcomes and costs compared to usual care. We developed and validated a computer simulation of type 2 diabetes based on published data from major clinical trials. The model tracks patients through microvascular and macrovascular health states and reports cumulative costs and quality adjusted life years. We modeled different scenarios that include a diabetes-specific nutritional meal replacement as part of a structured lifestyle intervention, and also as the only difference between the intervention and usual care treatment groups, and compared them to usual care with diet and physical activity recommendations. We used sensitivity analysis to explore the robustness of results. When a diabetes-specific nutritional meal replacement is the only treatment difference and is considered an equal cost meal replacement, the diabetes-specific nutritional meal replacement interventions are less costly and more effective than usual care. As an added cost meal replacement, the diabetes-specific nutritional meal replacement has an incremental cost-effectiveness ratio between $50,414 and $55,036 depending on improvement in percent glycated hemoglobin. A hypothetical lifestyle intervention using a diabetes-specific nutritional meal replacement has an incremental cost-effectiveness ratio of $47,917. The diabetes-specific nutritional meal replacement was found to be cost-effective under the various conditions simulated.