PDAs have been used for gathering data in several studies Taylor et al. PDAs are ideally suited as an intervention tool for several reasons: they are compact and portable, and for the most part self-explanatory in their operation. PDA prices have decreased significantly, leading to a wider use in the population. The use of the PDA in our study also provided a channel for interaction between the user and the provider.
Whereas further development of the software is ongoing, the option of immediate feedback on GI programmed into the PDA proved to be quite useful to participants. Use of the PDA GI software addresses some of the perceived barriers Franz, to the implementation of a low-GI nutrition intervention, as users are provided with readily accessible information on low-GI foods. As suggested by Henker and Colleagues Henker et al.
The Glycemic Index
We observed a decrease in HbA1c and a change in overall GI score during the study. In addition, GL decreased 27 points between baseline and 6 months, so the change in HbA1c may also be related to the decrease in GL. There are some weaknesses in our study, including lack of control group, small sample size, limited generalizability owing to population characteristics, need for refinement of the PDA food database and software, and potential measurement error of the GI score.
First, owing to the pilot nature and design of our study, we were unable to examine which components nutritionist or PDA of the intervention were most important in achieving the results. Given that there was only one arm, our results could be explained by the combination of the intervention, placebo effects, and regression to the mean. Second, firm conclusions about effectiveness cannot be derived from our data given the small sample size and demographic characteristics of the study population.
The fact that changes were generally in a consistently favorable direction, and that some changes were large enough to be statistically significant, however, is encouraging and indicates that a larger study is warranted.
Fibre, fat, protein
Participants were primarily white, highly educated, above average income levels and, although about half had no PDA experience, most had very positive attitudes towards the possibility that the PDAs would help them. Thus, generalizability is limited. This pilot study provided important information on efficacy, rather than effectiveness. We are investigating this further in a more diverse population, which is currently underway.
Third, the PDA database and software require further development. The PDA development would include expansion of the database to increase patient satisfaction with their ability to obtain information on common foods, and an automated and personalized feedback system, in as close to real time as possible. Finally, structured assessment instruments, such as the 7DDR, used in our pilot study, have been associated with a variety of measurement errors Hebert et al. Collapsing foods into groups, rather than using specific foods and food quantities, could increase measurement error of GI with the 7DDR.
Therefore, several h diet recalls, which utilize the multiple pass recall methodology, may generate greater accuracy in future studies; however, this is more labor intensive. The Dietary Guidelines for Americans Marlett et al. Optimal dietary management of diabetes may involve a combination of the two: decreasing the GI score of the diet, as well as the amount of carbohydrates consumed per day.
Diet is a fundamental component in the management of type II diabetes, but adherence to dietary recommendations is a challenging issue. Refinements in instruments that foster adherence are urgently needed.
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Technological devices such as the PDAs to promote adherence to dietary interventions via facilitation of food choices and real-time feedback appear to improve diabetes control. In conclusion, results of this pilot study support the feasibility of implementing a nutritionist-delivered, PDA-assisted, low-GI dietary intervention for patients with poorly controlled type II diabetes. Randomized controlled trials testing the efficacy of PDA-assisted low-GI diet on glycemic control are justified. Atkins RC Atkins' New Diet Revolution.
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Glycemic Index and Diabetes
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