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E. Metabolic/Endocrine Systems
E.2 Diabetes Mellitus
Content
Areas
- Glucose
metabolism
- Insulin
secretion and sensitivity
- Diagnostic
criteria and classification
- Epidemiology
- Hyperlipidemia
- Prevention
and lifestyle modification
- Physical
activity
- Medical
nutrition therapy
| After
training, the learner will be able to: |
| Knowledge
Objectives: Medical Students |
- Identify
the minimum components of a healthy diet and lifestyle for
the prevention of Type 2 diabetes.
- Describe
the most common macrovascular, renal, retinal, and neural
complications associated with diabetes mellitus and describe
the role of glycemic control and diet in reducing the secondary
complications of diabetes.
- Explain
how endocrine system control of nutrient metabolism maintains
energy balance in normal and diabetic individuals.
- Differentiate
between the short-term and the long-term effects of macronutrients
on insulin secretion and insulin sensitivity in diabetes
mellitus.
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| Knowledge
Objectives: Residents |
- Summarize
the current Nutrition Recommendations and Principles for
People with Diabetes Mellitus developed by the American
Diabetes Association and American Dietetics Association,
and compare and contrast the dietary goals for persons with
Type 1 vs. Type 2 diabetes.
- Describe
and classify the hyperlipidemia seen in patients with diabetes
mellitus, and explain how glycemic control, diet, and weight
loss can be used to correct plasma lipid levels.
- Explain
how to choose an appropriate drug therapy on the basis of
pharmacokinetics and endogenous insulin secretion and resistance.
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| Practice
Behavior Skills: Medical Students |
- Take
a thorough nutritional and physical activity history of
a person with diabetes, including an assessment of the (a)
family history of diabetes mellitus, (b) onset and duration
of diabetes symptoms, and (c) evidence of complications,
as well as the patient’s (a) weight history, (b) usual
dietary intake, (c) frequency, intensity, and duration of
physical activity, and (d) use of medications, and (e) alcohol
consumption, and identify any problem areas.
- Conduct
an appropriate physical examination for a patient with diabetes
including assessments of height, weight, Body Mass Index
(BMI), body fat, fundus, feet, vascular sufficiency and
peripheral neuropathy.
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| Practice
Behavior Skills: Residents |
- Given
a detailed scenario describing a patient with diabetes,
provide individualized dietary counseling that takes into
account insulin regimen, type of diabetes, total calorie
requirements for weight maintenance or weight loss, carbohydrate
counting, glucose and lipid goals, and timing of eating.
- Seek
consultation with a registered dietitian, a certified diabetes
educator, or other credentialed nutrition professionals
as appropriate.
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| Attitude
Objectives: All Learners |
- Demonstrate
a personal commitment to the importance of diet and exercise
in preventive medicine by serving as a positive role model
for patients with diabetes.
- Recognize
the central importance of nutrition in the maintenance of
health, and demonstrate a commitment to support patient
adherence to the Nutrition Recommendations and Principles
for People with Diabetes Mellitus accepted by the American
Diabetes Association.
- Recognize
the importance of patient self-motivation and demonstrate
a commitment to shared decision making with diabetic patients.
- Recognize
the value of utilizing a team approach in the treatment
of diabetes mellitus that includes registered dietitians,
certified diabetes educators, exercise physiologists, clinical
psychologists/behavioral medicine specialists, nurse practitioners,
and clinical pharmacists.
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