Nutrition 411: Diabetes and Wounds: Weight Loss as a Preventative Strategy
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Self-management of diabetes often is a daunting prospect for patients, particularly when newly diagnosed. Hearing they must test blood sugar, follow a new diet, engage in physical activity, take medications appropriately, and be concerned with comorbidity complications can be overwhelming. Although healthcare professionals (HCPs) are aware of the dangers of uncontrolled diabetes, patients often are not concerned until detrimental symptoms, such as a wound, occur. Diabetes and wounds is a dangerous combination; a wound is never simple for a patient with diabetes. According to the American Diabetes Association,1 25.8 million people in the United States have diabetes; currently, it is the sixth leading cause of death.
Often the simple act of losing extra weight can help with glucose control and in turn, wound healing; however, this is easier said than done. In order to maintain A1C levels below 7%, changes to diet and physical activity are recommended to facilitate weight loss, a challenge for most patients even though weight loss has been proven to improve glycemic control and reduce complications, thus, improving quality of life.2 Discussing the need for weight loss can be difficult for HCPs, but if a patient is at risk for developing further disease complications (eg, amputation), it is imperative that HCPs become comfortable and tackle weight issues head-on.
Stages of Change
Before giving suggestions for lifestyle changes and weight loss, it is important to determine if the individual is ready to make a change. The transtheoretical model of behavior change is a tool that is commonly used to determine a patient’s readiness to change. With this model, an individual is said to progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and relapse.3 An individual in the precontemplation stage is not thinking about the problem and does not intend to make any changes. Often this patient is not aware of the risks regarding his current behavior or lifestyle. This would be the time to simply provide information regarding the negative impact the behavior has on health. The HCP should approach the topic with sincerity and understanding and without judgment. Facts should be provided and subsequent action left to the patient.
If the patient is interested or becomes concerned, he/she has moved into the next stage of change: contemplation. In this stage, an individual becomes aware of a desire to change and usually will weigh the pros and cons of changing his behavior. It is most helpful to have an open discussion with the patient and provide support for making a change.
Once the individual believes the advantages outweigh the disadvantages of changing, he has entered the preparation stage. In this stage, a commitment to take action in the near future has been made. The HCP should encourage small steps and provide tips or suggestions related to the situation.
Creating a plan of action with the patient can be a helpful method to assist the patient into the action stage. This stage marks the beginning of actual change. The HCP needs to be aware that relapse is common in this stage if the individual has not sufficiently prepared for change. Providing encouragement and solutions for any barriers to change is important.
Once the individual has maintained the desired behavior change for at least 6 months, he is said to be in the maintenance stage. Relapse is less common is this stage; however, without continued support and guidance, regression to a previous behavior can occur.