UBC Theses and Dissertations
What adult insulin pump users know and do - the role of nutrition and carbohydrate counting in diabetes management Malkin, Alison Amrit
The role of nutrition in diabetes management is well documented, but little is known about the dietary practices of adult insulin pump users. This cross-sectional quantitative study was conducted to address this gap. An electronic survey was designed with the assistance of a national advisory group of diabetes health care (DHC) experts who identified nutrition domains relevant to flexible intensive insulin self-management. The survey was then used to explore the nutrition and carbohydrate counting practices, satisfaction with and sources of nutrition support, and glycemic control of adult Medtronic insulin pump users. Inter-relationships among these key factors were also explored. Adult pumpers (n=297) attained a nutrition knowledge scale score of 70.8±16.9% and relied on label reading 86.0±18.0% of the time. Gaps in nutrition knowledge included carbohydrate counting for low carbohydrate vegetables, glycemic index, and label reading with sugar alcohols. Nutrition knowledge scores were higher among those without severe hypoglycemic reactions (73.1±16.2% vs. 65.4±16.2%, t=3.275, p=0.001). Higher nutrition knowledge scale scores were also correlated with more favourable glycated hemoglobin (A1c) values (r=-0.171, p=0.006). Satisfaction was correlated with the number of DHC team members (r=0.412, p=0.001; mean 1.68±1.3). Dietitians (50.2%) and Diabetes Education Centres (DEC) (50.2%) were the most frequently reported sources of dietary support. “Self-educators” received higher nutrition knowledge scale scores compared to “non self-educators” (73.1±16.9% vs. 67.7±16.2%, t=2.614, p=0.004) but no difference in glycemic control was found between the two groups (7.2±1.0% vs. 7.2±1.0% A1c, t=0.614, p=0.539). Results support the concept of a positive correlation between nutrition knowledge and glycemic control. Satisfaction with nutrition support was linked to the size and scope of a person’s DHC team. Empowering adult pumpers to perceive themselves as “self-educators” may be an effective strategy to enhance nutrition knowledge and potentially improve glycemic control. Although this sample may not be representative of all Canadian adult insulin pump users, they were motivated and well educated about nutrition and carbohydrate counting, flexible intensive insulin self-management, and had good glycemic control.
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