Estimating Energy Intake
Patients with type 2 diabetes who accurately estimate their energy intake appear to have better controlled disease than do those who do not, said Yumi Matsushita of the Tokyo Medical and Dental University.
In a cross-sectional study of 46 men and 16 women with diabetes treated as outpatients in two Tokyo hospitals in 1999, a dietician had the patients estimate their recent dietary intake and expenditure. Patients then completed a self-reported survey of food intake for 3 days, and wore a pedometer for 1 week to measure physical activity.
Patients were broken into three groups based on hemoglobin A1c levels (HbA1c): low (6.6% or lower), medium (6.7%-7.5%), and high (7.6% or higher), the researchers said (Diabetes Res. Clin. Pract. 2005;67:220-6).
The mean energy intake was higher than recommended in all three groups, and the mean fat/energy ratio exceeded the recommended range of 25% or less in all groups. Total energy expenditure was significantly higher in the well-controlled group: 1,983 kcal/day versus 1,876 in the poorly controlled tertile, the researchers said. Physical activity intensity was similar in the three groups.
Patients whose estimated energy intake closely matched that recorded by dieticians tended to have better diabetes control. More than 35% of low HbA1c patients had a “close match” between estimated and real energy intake, compared with 13% and 11% of those in the medium and high HbA1c groups, respectively.
Costs of Diabetes Complications
Preventing hospitalizations for diabetes complications could save the health care system up to $2.5 billion of the approximately $3.8 billion in costs of such complications in 2001, including $1.3 billion paid by Medicare and $386 million paid by Medicaid, according to a report from the Agency for Healthcare Research and Quality.
Nearly one-third of all diabetes patients are hospitalized at least twice a year for complications. Patients who are racial/ethnic minorities, enrolled in public insurance, or living in low-income areas are especially likely to experience multiple hospitalizations and have higher hospital costs. Nonelderly adults on Medicaid have 55% more multiple hospitalizations than do privately insured diabetics, and Medicare patients have 48% more multiple hospitalizations, based on 2001 data.
Among all diabetics who are hospitalized, 30% are rehospitalized within a year, accounting for more than half of all diabetes-related hospital costs. “The total annual hospital cost per patient for all stays is nearly three times as high for patients with multiple hospitalizations as compared to patients with a single stay—$23,100 versus $8,500,” the researchers said.
Providers and policy makers should offer interventions for cardiovascular disease to diabetics, carefully monitor diabetics with a prior admission for diabetes complications, and consider enhanced interventions for vulnerable diabetes populations, such as minorities, low-income patients, and those on public health coverage, according to the report.
Drinking Patterns Matter
High body mass index is associated with heavy drinking sessions, but not with frequent drinking, reported Rosalind A. Breslow and Barbara A. Smothers of the division of epidemiology and prevention research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.
The researchers reviewed data obtained from the National Health Interview Survey on 37,103 (17,151 men and 19,952 women) current drinkers who had never smoked and whose mean age was 41 years. Men drank a mean of 73 days per year, while women drank 43.5 days per year. The mean number of drinks consumed per drinking day was 2.5 for men and 1.7 for women (Am. J. Epidemiol. 2005;161:368-76).
Among all drinkers, those who consumed at least four drinks per drinking day had significantly higher BMI than did those who consumed just one drink per drinking day.
BMI increased across all drinkers as alcohol intake per drinking day increased, from 26.5 kg/m
“BMI was significantly lower among the most frequent drinkers as compared with the least frequent drinkers” for both women and men, but the effect was more pronounced in women than in men, the investigators said.