Disease Management Update
Volume V, No. 35
January 15, 2009

Dear Healthcare Intelligence Network Client,

As the second full week of the new year winds down, many people are still trying to hold on to resolutions they've made for 2009. A very common resolutions made the world over revolves around eating habits. This week's Disease Management Update features a new invention that promotes healthy eating habits and shares a study that explores a link between eating healthier and controlling type 2 diabetes.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Low-Carb Diets Prove Better at Controlling Type 2 Diabetes
  2. Disease Management Q&A: Participant Challenges as Motivators
  3. HealthSounds Podcast: Coaching the Binge Eater
  4. New Invention Brings Success to Lifestyle Behavior Modification
  5. Survey of the Month: ED Access and Overcrowding
  6. Employer-Sponsored Weight Management Programs — The Business Case

1. Low-Carb Diets Prove Better at Controlling Type 2 Diabetes

In a six-month comparison of low-carb diets, one that encourages eating carbohydrates with the lowest possible rating on the glycemic index leads to greater improvement in blood sugar control, according to Duke University Medical Center researchers. Patients who followed the no-glycemic diet experienced more frequent reductions, and in some cases elimination, of their need for medication to control type 2 diabetes, according to lead author Eric Westman, M.D., director of Duke's Lifestyle Medicine Program.

"Low glycemic diets are good, but our work shows a no-glycemic diet is even better at improving blood sugar control," said Dr. Westman. "We found you can get a three-fold improvement in type 2 diabetes as evidenced by a standard test of the amount of sugar in the blood. That's an important distinction because as a physician who is faced with the choice of drugs or diet, I want a strong diet that's shown to improve type 2 diabetes and minimize medication use."

Eighty-four volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate ketogenic diet (less than 20 grams of carbs/day) or a low-glycemic, reduced calorie diet (500 calorie deficit). Both groups attended group meetings, had nutritional supplementation and an exercise regimen. After 24 weeks, their glycemic control was determined by a blood test that measured hemoglobin A1C, a standard test used to determine blood sugar control in patients with diabetes. Of those who completed the study, the volunteers in the low-carbohydrate diet group had greater improvements in hemoglobin A1C. Diabetes medications were reduced or eliminated in 95 percent of the low-carbohydrate volunteers, compared to 62 percent in the low-glycemic group. The low-carbohydrate diet also resulted in a greater reduction in weight.

To learn more about this research, please visit:

2. Disease Management Q&A: Participant Challenges as Motivators

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Gregg Lehman, Ph.D., former president and CEO, Gordian Health Solutions, and current president and CEO of HealthFitness.

Question: Can you give some examples of successfully engaging participants using participant challenges?

Response: (Gregg Lehman) We get many participants in weight management programs or obesity DM programs. In many cases, they’ve had failures or limited success with specific diets or weight loss regimens. Quarterly, we review the program this participant has been following, and if the program’s been successful, we will not modify it. The participant challenge might be if you’ve been taking the elevator up two stories to your office, the challenge that month is to take the stairs for three days a week, providing, of course, that their physician says there are no other health risks involved. Another participant challenge might be something as simple as switching the spread that they use on their bread from butter to a cholesterol-lowering spreads. Just doing simple things like those examples can be a challenge. Through participant feedback, we find this is a positive motivation. It moves them — in manageable steps — toward improving their overall lifestyle and behavior. With different programs there are different challenges. Our health coaches are charged to be interactive with the participants in designing programs based on what they think will work with that participant, rather than just working from a rote set of criteria that they superimpose on these individuals. This gives them a lot of freedom to design challenges that they think will produce satisfactory results.

For more details on behavior modification, please visit:

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3. HealthSounds Podcast: Coaching the Binge Eater

For HealthMedia, Inc., the notion of health coaching without a coach is proving to be very successful for their patients in many areas. Dr. Richard Bedrosian, Ph.D., HealthMedia director of behavioral health, and Caren Kenney, director of corporate communications, discuss HealthMedia's Binge Eating Disorder (BED) program, a first-of-its-kind solution aimed at addressing binge eating disorder and its impact on healthcare costs in the United States. Dr. Bedrosian and Kenney also talk about what spurred the idea for the program, how it works and the benefits, challenges and drawbacks that go with this innovative new wave of Web-based coaching.

To listen to this complimentary HIN podcast, please visit:

4. New Invention Brings Success to Lifestyle Behavior Modification

A group of inventors at the University of Nebraska Medical Center and its hospital partner, The Nebraska Medical Center, have developed a new tool to help patients reach their health-eating goals. The tool is called the A-Wrist-A-Trac, a lifestyle behavior modification system that utilizes wrist bracelets to track and promote healthy eating habits throughout the day. Based on the USDA food pyramid, the bracelets are color coded and available in either rustic fall or pastel spring colors. A user guide accompanies both sets.

Inventors Kathi Healey, Ph.D., Terry Munsinger, R.N., dietician Jill Skrabel and Dottie Norgard, L.P.N., initially developed the idea to help individuals lose weight through the establishment of healthier eating habits. They soon realized that the A-Wrist-A-Trac could be used to modify many other lifestyle behaviors. Additional versions are being developed for healthy eating habits for children and diabetic management.

"Behavior modification is hard work and practical techniques to aid in changing behavior on a daily basis are a key factor in making changes," said Dr. Healey, the primary inventor. "Studies have shown that if individuals track and/or monitor behaviors, they are more likely to succeed at modifying them. These bracelets are a very easy way to guide and monitor behaviors. It's simple — once an action is performed, the color-coded bracelet is moved to the opposite wrist."

To learn more about this research, please visit:

5. Survey of the Month: ED Access and Overcrowding

An economy that is creating more unemployed and uninsured individuals is just one factor contributing to a rise in ER use and a decline in patient satisfaction. In its National Report Card on the State of Emergency Medicine for 2009, the American College of Emergency Physicians has given the United States an overall grade of C-, largely due to poor ratings for access to emergency care. Is emergency room overcrowding an issue for your organization, and if so, how are you responding to this? Complete HIN's Survey of the Month on emergency room access and overcrowding and receive a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Employer-Sponsored Weight Management Programs — The Business Case

This white paper details the significant benefits to organizations that invest in proven weight control strategies at work. The paper cites more than a dozen studies highlighting the ROI in terms of health risks, costs and worker productivity and offers employers solutions to the growing crisis.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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