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Change lifestyle to reduce diabetes

Experts have suggested that an intensive lifestyle intervention helps individuals with type 2 diabetes lose weight and keep it off, along with improving fitness, control of blood glucose levels and risk factors for cardiovascular disease. Improving blood glucose control and cardiovascular risk factors in patients with type 2 diabetes is critical in preventing long-term complications of the disease.

The Look AHEAD (Action for Health in Diabetes) Research Group conducted a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention to diabetes support and education among 5,145 overweight individuals with type 2 diabetes.

Of these, 2,570 were assigned to the lifestyle intervention, a combination of diet modification and physical activity designed to induce a 7 percent weight loss in the first year and maintain it in subsequent years. The 2,575 individuals assigned to the diabetes support and education group were invited to three group sessions each year. On average, across the four-year period, individuals in the lifestyle intervention group lost a significantly larger percentage of their weight than did those in the diabetes support group.

They also experienced greater improvements in fitness, hemoglobin A1c level (a measure of blood glucose), blood pressure and levels of high-density lipoprotein. Individuals in the diabetes support group, on the other hand, experienced greater reductions in low-density lipoprotein, owing to greater use of cholesterol-lowering medications in this group.

The report was published in the September 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

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People with mild cognitive impairment can be affected by a reduction in their ability to think, such as reduced memory and a short attention span.
“We wanted to find out whether highly educated patients with mild cognitive impairment differed in terms of tolerance of the disease from patients with intermediate and low levels of education,” says Rolstad.

By analysing the patients' spinal fluid, the researchers were able to examine whether there were signs of dementia in the brain.
“Highly educated patients with mild cognitive impairment who went on to develop dementia over the next two years had more signs of disease in their spinal fluid than those with intermediate and low levels of education,” says Rolstad.
Despite having more disease in the brain, the highly educated patients showed the same symptoms of the disease as their less well educated counterparts. This means that patients with higher levels of education tolerate more disease in the brain.

The researchers also studied patients with mild cognitive impairment who did not go on to develop dementia over the next two years.
“We found that the highly educated patients who did not develop dementia during the course of the study showed signs of better nerve function than those with lower levels of education,” says Rolstad. “This finding means that the highly educated not only tolerate more disease in the brain but also sustain less nerve damage during the early stages of the disease.”

The results indicate that a higher reserve capacity delays the symptoms of dementia and the progress of the disease. This can help the care sector to be more aware of dementia in highly educated patients, and thus increase the chances of the correct treatment being given.

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Becoming a Dietitian

Would I enjoy a career as a dietitian?

If you are interested in food, nutrition and health, enjoy communicating with people and have an aptitude for science – an exciting future lies ahead of you when you become an Accredited Practising Dietitian (APD).

Dietitians need to have a critical and enquiring mind, good organisational skills and initiative, good written and verbal communication skills, and be able to work effectively with people.

What do dietitians do?

Dietitians apply the art and science of human nutrition to help people understand food and health relationships and make dietary choices to get the most out of their lifestyle.

Dietitians are trained to:

  • understand food science;
  • interpret nutrition science;assess people's nutritional needs;
  • advise on nutrition and diet for general good health or for special needs such as sport or medical conditions;
  • implement and manage nutrition services and programs;
  • teach others;
  • undertake research; and
  • develop nutrition communications, nutrition programs and policies.

What are my career options?

The diverse range of job opportunities and working conditions for dietitians will enable you to develop a wide variety of interests and skills and use them in many different situations.

  • Patient care Working as part of a health care team in hospitals and nursing homes, dietitians are responsible for assessing the nutritional needs of patients, planning appropriate diets and educating patients and their families.
  • Community nutrition and public health Dietitians are involved in nutrition and health education programs. This can be at the local community level or for the population at a national level. Dietitians working in public health also assist with health planning, setting nutritional standards, and developing and implementing nutrition policies.
  • Food service and management Dietitians combine management skills and nutrition expertise when delivering food services in hospitals, nursing homes, meals on wheels, hospitality and catering. Dietitians also manage nutrition services and health programs.
  • Consultancy/private practice Dietitians provide consultancy services to individuals, groups and organisations which include individual counselling, group programs, preventive health programs and nutrition education. Dietitians also prepare nutritional information for publication, work with the media and in public relations.
  • Food industry Dietitians working in the food industry are involved in food regulatory issues (food law), food safety and quality systems, consumer and health professional education, nutrition research, product development, nutrition-related marketing and public relations.
  • Research and teaching Dietitians work as part of research teams investigating nutrition and health issues and developing practical nutrition recommendations. Dietitians are also involved in training student dietitians, doctors and other health professionals.
  • Other fields Dietitians are able to transfer their skills to other fields such as management, public relations, marketing, program management, communications, media, health promotion, policy development and information technology.

What are the salaries – public sector and private practice fees?

In the public healthcare sector dietitians' salaries are similar to other allied health professionals, nurses and teachers. To find out about salaries you should visit the website of the relevant State/Territory Departments of Health or obtain the relevant awards (eg Health Professionals), collective agreements or enterprise agreements in your State or Territory.

In other work areas dietitians' salaries reflect salaries for that industry, e.g. university lecturers. It is against the Trade Practices Act for DAA to set or recommend fees therefore dietitians in private practice or consulting do set their own fees. DAA does survey members on what fees are being charged and the survey results are provided as a guide to what you may expect to pay if consulting a dietitian.

What course do I select?

To become a dietitian you need to complete a tertiary level course accredited by DAA. Currently there are courses in ACT, New South Wales, Queensland, South Australia, Victoria and Western Australia. Courses vary depending on the university. Some examples of current courses include: a one to two year post-graduate diploma or master degree following a bachelor of science degree (including physiology and biochemistry), or a four year integrated undergraduate course. Courses cover food, nutrition, health and diet-related medical conditions, and skills in communication, counselling, education, health promotion, management, research and critical analysis of literature.

How will my expertise be recognised?

Accredited Practising Dietitians (APD) are recognised professionals who have the qualifications and expertise to provide expert nutrition and dietary advice. APDs need to meet detailed criteria developed by DAA. These include ongoing education to keep up to date with advances in health and food sciences and a commitment to a Code of Professional Conduct. All APDs can be identified by the APD title and logo, and are listed on a national APD register.

Source: Dietitians Association of Australia

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When and how to make a referral

A referral to Nastaran Habibi should be made when your patient needs more intensive dietary, nutritional and lifestyle behavior education than you can provide in your office environment. Nastaran can help particularly when the patient is in the preparation, action or relapse stages of change.

A consultation generally includes a diet and lifestyle assessment, and nutrition education and counselling. Nastaran will review your patient’s medical and social status, including biochemistry and othe relevant test results, dietary and family history and home environment. In addition she will take anthropometric measurements and collect information on the patient’s individual food preferences and cultural, socio-economic and lifestyle needs. Taking into account the patient’s own goals, knowledge, skills and access to resources, Nastaran will custom design a program for your patient based on the principles of Medical Nutrition Therapy. She integrates self-management training regarding information on nutrient content, food choices, and meal preparation based on each patient’s particular and unique circumstances. Initial appointments are more than 1 hour.

What happens next:

  • You will receive a formal report assessing your patient’s nutritional, physical activity and lifestyle status including Nastaran’s recommendations for improvement, possible barriers to success and guidelines for evaluating progress.
  • During the 45-90 minute follow-up visits, Nastaran will review your patient’s progress, provide further education, encourage continued adherence to the plan and identify any obstacles to success.

In order for your patient to qualify for a Medicare rebate, referral must be through an Enhanced Care Plan. Referrals outside Medicare will still qualify for a Health Fund rebate.

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