Cath Lab Digest

Start Page: 8    Maintaining anutritious diet and exercise plan is paramount for patients with diabetes in order to reduce the risk of complications from the disease. For pre-diabetic patients, making such lifestyle changes may also be helpful in warding off diabetes. Encouraging pre-diabetic patients to change their habits was a primary focus of discussion recently at the American Diabetes Association (ADA) 65th Annual Scientific Sessions.    Participants in the ADA sessions cited several studies, including the Diabetes Prevention Program and the Finnish Diabetes Prevention Study, that show the positive impact of routine diet and exercise counseling in addressing metabolic issues in patients with pre-diabetes and polyneuropathy.    The ADA also noted the findings of the Impaired Glucose Tolerance Neuropathy Study, in which patients performed 150 minutes of moderate exercise every week. These patients were also asked to decrease fat calories to under 30 percent of their total food intake and lose 7 percent of their body weight over 48 weeks, according to an article in the Doctor’s Guide. The study results showed that diet and exercise improvements led to improved metabolic function and improvements in measures of peripheral neuropathy, according to the ADA.    Although lifestyle changes are effective in slowing the progression of diabetes or preventing the disease, Eric Espensen, DPM, says many patients do not grasp the severity of diabetes. He lauds the ADA’s group encounter meetings as “gold mines” and notes that many hospitals have monthly diabetes meetings to educate patients.    For patients with pre-diabetes or those who are borderline diabetic, controlling diet and exercise is vital, according to Eric Feit, DPM. He says planning a specific diet plan for each day is critical and prefers the Atkins diet as it is easy for patients to remember. The diet stresses cutting back carbohydrates like bread, rice, pasta, cookies and cakes. Dr. Espensen urges patients to keep a journal of the food they eat for a week.     “The patients are amazed at how much they eat and they can start to make simple changes in their diets,” says Dr. Espensen, the Associate Director and Director of Research at the Providence Diabetic Foot Center in Los Angeles.    Having a daily exercise program is also important, notes Dr. Feit, the Past President of the Los Angeles chapter of the ADA. He says patients should start by buying a good pair of running shoes and a soft OTC orthotic like a Spenco Polysorb Cross-Trainer or Sof Sole Athletic Plus. Dr. Feit points out that senior citizens like these orthotics because their feet feel better and they are able to walk more.    Dr. Feit asks his patients to walk 30 minutes each day and suggests settings like the park, the mall or the supermarket. Dr. Espensen concurs, emphasizing that having patients walk 30 minutes a day is “priceless” in facilitating weight loss.

Encouraging Compliance From Difficult Patients

   What can podiatrists do to encourage compliance in adult patients who simply do not want to change their habits? Dr. Feit says one can encourage a new diet or exercise program by showing pictures of patients with diabetic wounds, gangrene or amputations. Following that, he enumerates the risks of diabetes and how keeping blood sugar under control can prevent such complications.     “Sometimes a visual stimulus is the best way to get a patient to realize the serious risks involved with being diabetic,” says Dr. Feit of showing non-compliant patients photos of complications.