Dr. Carla Miller, assistant professor of nutrition at Penn State and leader of the study says, "Changing what you eat at any age is difficult and changing after age 65 can be especially hard. Nevertheless, the men and women in our study, all of whom were 65 years of age or older, not only changed their diets but also had greater improvements in their blood sugar and cholesterol levels than did people who were not counseled through our new approach."
The study, "Nutrition Education Improves Metabolic Outcomes Among Older Adults with Diabetes Mellitus: Results from a Randomized Controlled Trial," is detailed in the current (Feb.) issue of the journal, Preventive Medicine. The authors are Miller; Lesley Edwards, Miller's former graduate student; Dr. Grace Kissling, professor of mathematical sciences UNC-Greensboro; and Laurel Sanville, dietitian, UNC Greensboro.
Miller says there are few nutrition education programs for older diabetic adults. Most programs are designed for the younger adult, or those recently diagnosed with the disease, even though the incidence of diabetes increases with age. Diabetes affects more than 14 percent of the population over age 65. The new program was designed specifically for older adults and offered data in smaller chunks to prevent "information overload." There were 10 weekly sessions lasting one to two hours in which participants were taught how to evaluate the nutrition information on food labels for food purchasing, meal planning and diabetes management. For example, the carbohydrate, fat and cholesterol information on the food label were discussed in the sessions along with product claims to combat misconceptions about label inaccuracies and marketing "gimmicks."
Participants were also offered tips for saving money at the supermarket to counter their belief that it was too expensive to eat a healthful diet. One session was conducted in a supermarket so the participants had an opportunity to apply the principles they learned.
Participants were also offered guided activities throughout the program to strengthen their knowledge and skills. At each group session, participants set a weekly goal and reward to help reinforce behavior changes. They were also encouraged to monitor and record their dietary intake and blood sugar values during the week to identify patterns.
Comparing data from pre and post tests showed that the nutrition education improved blood sugar control to levels that reduce the risk for large blood vessel complications, a major risk factor for diabetics and a strong predictor of coronary heart disease. Significantly more of the people who participated in the educational sessions also met the treatment goals for lowering total cholesterol.
The authors note that while there was significant improvement in participants' cholesterol numbers, only 35.9 percent achieved the ideal level of less than 200 mg/dl. However, they point out, "The relationship between dietary fat and saturated fat intake and risk factors for cardiovascular disease were not discussed until week six of the intervention, and the recommendations for total and saturated fat intake were not presented until week seven of the intervention. Post-test data collection occurred immediately after week 10 of the intervention. Therefore, the time period between when many participants reported making changes in their total and saturated fat intake and the posttest assessment may have been insufficient. At least 3-4 weeks are needed for plasma lipoproteins to reach stable endpoints in controlled feeding studies."
"The study shows that older diabetic adults can and will make the necessary changes in their diet if they are offered appropriate support. Unfortunately, at present, Medicare will only pay for 10 hours of instruction per year – which may not be enough to have a lasting effect, " Miller adds.
The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Disease.
Journal
Preventive Medicine