RedScrubs
The Resource for Medical Professionals

This study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have heart failure, hypertension, renal dysfunction and ejection fraction < 50%. The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.

In a study published in the June, 2008 issue of The American Journal of Medicine the cut-off level for determining diabetes was again challenged. After looking at 46, 578 members of Kaiser Permanente it was found that subjects developed diabetes at a rate of 1% per year. Subjects were assigned to 1 of 4 categories of blood sugar levels (<85, 85-89, 90-94, or 95-99 mg/dl). They were followed for 81 months.

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors (i.e. body mass index, blood pressure, lipids, smoking, cardiovascular disease and hypertension) suggests that diabetes risk increases as fasting plasma glucose increases, even within the currently accepted normal range. For example, for each mg. per deciliter of fasting plasma glucose diabetes risk was increased by 6%. Subjects with glucose levels of 95-99 were 2.33 times more likely to develop diabetes. Subjects in the 90-94 mg/dl group were 49% more likely to progress to diabetes.

Food diaries are records of everything that you eat in a day and can be simple or complex. It is not unusual for an RD to ask you to bring in a three day food diary to your first appointment so the assessment can include an overall view of what the current diet looks like. Then, typically, the patient is asked to keep a record of the daily food intake with corresponding values for calories,protein, fat, carbohydrate and fiber so patients can learn how to balance their food intake to achieve the optimal intake of nutrients and decrease intake of nutrients that are too high. The record also is reviewed at follow-up appointments with the RD where suggestions are made on ways to improve intake so nutritional goals are achieved.

A recent study looked at the effect of keeping a food diary and the amount of weight loss relative to the record keeping. According to the Kaiser Permanente Study, keeping the food diary doubled weight loss over the course of the study and the more food records people kept, the more weight they lost. The study looked at 1,700 participants who were instructed to follow the DASH diet rich in fruits and vegetables and low in fat. Weekly group sessions and exercise for 30 minutes per day were encouraged.

The authors concluded that keeping a record of what you eat makes you more aware of what you are eating and where your bad habits are. Food journaling in conjunction with a good weight management program is a great combination of tools and support.

For more information see http://www.kpcmi.org/weight-management/index.html

A study done at Joslin Medical Center has shown that following a prescribed diet is associated with better glycemic control in Type I diabetes. The researcher stated that in recent years treatment had shifted focus from diet to medications and technologies. In this study the importance of diet was evaluated.

The study followed 119 children aged 9-14 and surveyed the parents on how closely their children followed prescribed dietary intake like carbohydrate counting, balancing insulin dose to carbohydrates consumed, and the quality of the diet itself including sweets and fats.

In a study published in the June, 2008 issue of The American Journal of Medicine the cut-off level for determining diabetes was again challenged. After looking at 46, 578 members of Kaiser Permanente it was found that subjects developed diabetes at a rate of 1% per year. Subjects were assigned to 1 of 4 categories of blood sugar levels (<85, 85-89, 90-94, or 95-99 mg/dl). They were followed for 81 months.

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors (i.e. body mass index, blood pressure, lipids, smoking, cardiovascular disease and hypertension) suggests that diabetes risk increases as fasting plasma glucose increases, even within the currently accepted normal range. For example, for each mg. per deciliter of fasting plasma glucose diabetes risk was increased by 6%. Subjects with glucose levels of 95-99 were 2.33 times more likely to develop diabetes. Subjects in the 90-94 mg/dl group were 49% more likely to progress to diabetes.

A study recently published in the Journal of Alzheimer’s Disease found memory impairment in rats fed a diet high in cholesterol and saturated fat. This memory loss appeared to be caused by an inflammatory process in the brain that occurred as a result of the high fat diet provided to the rodents. There was also impairment in the structural proteins involved in how a nerve cell functions. As inflammation is associated with a poor diet, the failure of functions in other key organs such as the eye and the ear are hypothesized.

Loss of memory with advanced age is a problem in most societies and is noted to be particularly severe in industrialized nations. We are a nation of fast food – notably high in fat, saturated fat in particular, and cholesterol.

In a precedent setting case, the Federal Trade Commission (FTC) is being sued by Native Essence Herb Company and its owners, Mark and Marianne Hershieser. A New Mexico herb company, Native Essence, says that the First Amendment gives it the right to tell customers the historical use of herbs in treating serious diseases. The FTC states that this practice violates its guidelines.

The issue is now headed toward court according to attorney Richard Jaffe, Esq., a leading health care attorney who is also the author of “Galileo’s Lawyer”, an insider’s look into the battles between the government and complementary medicine.

The company owner, Mark Hershieser, wants to post historical use information on his website and he wants the courts to allow that right. Most of the information posted has been taken from federal government websites, ironically.

Almost all of the patients over 70 residing in a Melbourne Australia teaching hospital were either malnourished or at risk of becoming malnourished a recent 2008 study showed. Malnutrition in hospitals is not a new entity. Looking at data from 1996, an article was published on the problem at hand in the United States where the study cited a prevalence of malnutrition to be 40-55% of the patients studied in the survey. Over 1,000 patients participated in this 1996 study in the U.S.

In the Melbourne study, 100 patients over the age of 70 were reviewed and 1/3 of them were found to be malnourished and 2/3 were found to be at risk for malnutrition.

A wide range of products claiming to lower blood sugar are marketed to the public. Individuals with diabetes are 1.6 times more likely to use complementary and alternative medicine than those without diabetes according to a recent study published in the April, 2008 supplement to the Journal of the American Dietetic Association (JADA). Reasons for using alternative medicine have been reported to include:
• Troublesome side-effects from conventional drug therapy
• A need for more personal control over one’s care plan
• The increasing cost of prescription drugs
• Dissatisfaction with conventional health care providers
• The ability to spend quality time with alternative practitioners, i.e. doctors do not spend enough time educating and talking to their patients so patients choose to go to those who will spend the time.
Several problematic areas may come up with the use of alternative therapies and pharmacists and Registered Dietitians are uniquely poised to address issues such as potential side-effects, drug interactions, lack of product standardization and the need for evidence-based information on the supplements being used.