Happy Thanksgiving to all of you! Have you seen the Healthy Thanksgiving Plate guide that just came out? What a great resource for our patients! Because of the holiday, I've been thinking a lot about food and particulary about my type 1 patients and their eating habits.
I recently reviewed a considerable amount of evidence based literature focused on healthy eating education for individuals with diabetes. As I looked through the types of interventions and outcomes, I was shocked to see nothing in the literature reviewed healthy eating outcomes for patients with type 1 diabetes! Have we totally missed this population in DSME? Is the effort to alter insulin dosing based on carbohydrate intake so overwhelming that we don’t consider education on healthy eating a focus of our work? How many classes in centers have structured DSME classes focused on patients with type 1 diabetes which includes a healthy eating component? What about all the aspects of the AADE7 communicated to individuals with type 1 diabetes?
We have a large population of patients with type 1 diabetes in our practice, and I have considered providing group classes to that specific population over the last year, but have yet to attempt it. A presentation and discussion on the importance of a well-balanced diet, not just carbohydrate counting, would be the focus. It could also provide a positive forum for recipe exchanges, and what to choose when eating out. The classes would follow the standard AADE7, integrating pattern management in regards to monitoring, medications used to treat and prevent co-morbid conditions (risk reduction) and healthy coping. It could also provide a great sharing of problem solving, a cornerstone of patients taking care of their type 1 diabetes. Although patients with type 1 and type 2 diabetes could be incorporated into the same classes, the etiology and diligence for management are so different I believe they each deserve their own focus. Integrating the “type 1.5” patient could be a consideration, due to their similarities in blood glucose volatility, and insulin requiring regimens.
I realize type 2 diabetes is so much more prevalent than type 1 diabetes. However, I think we should not lose sight of the patient with type 1 diabetes when it comes to basic diabetes education within a group support atmosphere. In addition, many of these patients were diagnosed as children, and an update in their understanding of optimal diabetes self-management should be reviewed.
I would enjoy hearing from anyone who has provided group DSME to individuals with type 1 diabetes, the format for your program (4 week, 1 day; evening, weekends; group discussion, lecture) and your take home messages for us all! I also encourage researchers to include appropriate eating strategies for individuals with type 1 diabetes, how to achieve those outcomes, and measurements of success in regards to types of interventions and healthy eating outcomes.
Have a wonderful and safe Thanksgiving, everyone!