Readers:

Twenty million Americans have diabetes, and diet plays an
important role in controlling the disease. Feeling over-
whelmed with all the options? Check out this video!

Watch: Delicious Diabetic Diets

Regards,
Steve

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Moms fret about diabetes

Before she became pregnant, Molly Duerr never understood
why expectant moms would say they didn’t care if it were
a boy or a girl, only that the baby be healthy.

“I thought, ‘Of course you’d want to know what the baby’s
going to be,’” says Duerr, 30, who has type 1 diabetes.
But after becoming pregnant last year and realizing all
the health risks associated with diabetes, she says, “I
got it.”

A growing number of women, like Duerr, are either heading
into pregnancy with diabetes — type 1 and type 2 — or
developing gestational diabetes while pregnant, says
endocrinologist Sue Kirkman, vice president of clinical
affairs for the American Diabetes Association. Kirkman
says diabetes raises the risk of miscarriages, delivery
complications, maternal health problems and birth defects,
but she adds that the risks can be slashed with pre-
conception counseling, tight control of blood sugar and
maintaining a healthy weight before and during pregnancy.

“There are many concerns women with diabetes grapple with,
everything from childbearing worries and premature cardio-
vascular disease to greater financial burdens,” says Ann
Albright, director of Diabetes Translation at the Centers
for Disease Control and Prevention.

Women who go into pregnancy already diagnosed with diabetes
have what’s called pre-gestational diabetes. Diabetes that
develops during pregnancy is referred to as gestational
diabetes.

Almost five out of every 1,000 women ages 18 to 44 have
diabetes, according to the CDC. Most have type 2 diabetes,
which is linked to obesity.

Gestational diabetes, which typically is tested for around
the 28th week of pregnancy, occurs in about 4% of patients,
says Helain Landy, chairwoman of the department of
obstetrics and gynecology at Georgetown University
Hospital. “From an epidemiological standpoint, that is a
lot,” Landy says.

Problems linked to the disease

Diabetes during pregnancy can cause high blood levels of
glucose, which can lead to health problems in mothers
and babies alike. When extra sugar in the mother’s blood
crosses the placenta to the fetus, a baby can have organ
malformation (in mothers with pre-existing diabetes) and
grow too large, leading to delivery complications.

For women with existing diabetes, pre-conception counseling
is paramount to a healthy pregnancy and baby and should
begin when girls with diabetes are as young as 13, says
Denise Charron-Prochownik, associate professor of health
promotion and development at the UPMC School of Nursing
and Graduate School of Public Health. “But it’s not happen-
ing,” she says.

Though Duerr and her husband sought out medical advice
about six months before she conceived, Kirkman says
surveys suggest only about half do the same.

A pre-gestational diabetic woman’s hemoglobin A1C, a test
that gives an average blood glucose reading over a two-
to three-month period, should be in the 6% to 7% range
before conception, says Florence Brown, co-director of
the Joslin Beth Israel Deaconess Medical Center’s Diabetes
and Pregnancy Program in Boston. Brown says some may aim
lower, but not if they have frequent or severe bouts of
low blood sugar, called hypoglycemia.

In June, Diabetes Care published a study by University of
Southern Denmark researchers who found that the risk of
serious outcomes increased gradually when A1C levels were
above 6.9%. Adverse outcomes doubled when levels reached
10.3%, and readings 10.4% or greater quadrupled risks.

Increasing awareness

With gestational diabetes, Kirkman says, the key is to keep
weight and blood sugar under control with a healthy diet,
exercise and sometimes insulin.

It’s not easy, Charron-Prochownik says. “Women have to be
very motivated.”

Brown, who is studying cardiovascular risks in women who
had gestational diabetes, says many do not realize that
they are more likely to develop cardiovascular disease or
that their baby has a greater chance of developing diabetes
later in life.

To help lower the risk of similar pregnancies and health
risks, next month the ADA and the American College of
Obstetricians and Gynecologists plan to launch a joint
awareness campaign that targets women during and after
pregnancy.

“We’re giving ideas to help continue healthy behaviors for
the whole family,” Kirkman says.

Duerr says she’s not sure about getting pregnant again
anytime soon.

“Having diabetes during pregnancy took a lot of work. It
was very challenging,” she says. “There were a lot of
nights my husband and I were both up because my glucose
monitor was going off because my sugar was too high or
too low. To have that level of commitment, to think about
doing it again now with our baby, is hard.”

Copyright 2009 USA TODAY, a division of Gannett Co. Inc.

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Early Telemedicine Try Didn’t Cut Medicare Costs

NEW YORK (Reuters Health) – A telemedicine program designed
to help Medicare beneficiaries with type 2 diabetes take
care of their health didn’t cut costs, and had only a
“modest” effect on patients’ health, researchers report in
the journal Diabetes Care.

But that doesn’t mean that similar interventions can’t help
patients and reduce health care spending, according to
Dr. Lorenzo Moreno of Mathematica Policy Research, Inc.,
in Princeton, New Jersey, who led the research.

“Increased home-based tele-visits from nurses and self-
tracking of progress could improve patients’ self care
behaviors,” Moreno noted in a statement. “These improve-
ments could help participants avoid long-term health
complications, which in turn would reduce use of acute
care services, hospitalizations, and Medicare costs.”

Medicare commissioned the current study, conducted in
2000-2002, as an independent test of the cost impacts
and clinical benefits of the Diabetes Education and
Telemedicine (IDEATel) program. Participants included
people aged 55 and older on Medicare who lived in parts
of New York State with limited access to doctors and
other health care professionals.

The program used a desktop PC that allowed patients to
check and track their blood sugar and blood pressure,
have video conferences with nurse case managers, and
use educational materials on the Web. The current study
looked at two phases of the program, conducted at one
site in New York City and another in upstate New York.
In the second phase, the home telemedicine unit was
redesigned to make it less cumbersome.

The researchers looked at two groups of patients: 1,665
who were included in the first two phases, and another
504 in the second phase only. All were randomized to
receive standard care or “intensive nurse case management”
via telemedicine.

There was no reduction in health care costs for the
patients in the telemedicine group, the researchers report;
in fact, these costs were 71% to 116% higher than they were
for the control group.

The program was so costly, the researchers say, because
the home telemedicine units were expensive, and the budget
of the project was quite large.

However, they noted, other telemedicine programs have been
shown to cost much less.

“With adjustments, a Medicare program such as this might
provide real benefits to beneficiaries,” Moreno predicts.

SOURCE: Diabetes Care, July 2009.

Copyright Reuters Limited. All rights reserved.

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Diabetic Recipe

Fresh Fruit Slush

(makes 4 servings)

1 1/2 cups (225 g) chopped fresh fruit or unsweetened
frozen fruit of your choice

8 to 10 ice cubes

1. Using a food processor or blender, blend the fruit
until smooth.

2. While machine is running, add the ice cubes one at a
time until the mixture takes on a slushy consistency.
Pour into glasses and serve immediately.

Per serving: 25 calories (6% calories from fat), trace
protein, trace total fat (0 saturated fat),
6 g carbohydrate, 1 g dietary fiber,
0 cholesterol, 0 sodium

Diabetic exchanges: 1/2 carbohydrate (fruit)

Copyright 1997-2001 Diabetic-Lifestyle.

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