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PurposeMore than 7 million Americans who have diabetes use insulin therapy. The majority continue to use syringes and vials or traditional insulin pens to deliver their insulin doses. Using these tools to deliver insulin presents numerous challenges for both the person with diabetes and their clinicians. This article provides an in-depth introduction to a new category of insulin delivery devices and integrated management systems, referred to as smart insulin pens. The article includes information about how these integrated insulin delivery systems can reduce many of the challenges of rapid-acting insulin dosing via injection by enabling easier and more accurate dose recording, dose calculations, and sharing of diabetes management data with clinicians. This article also discusses new roles for diabetes care and education specialists in diabetes data-driven care and practice and addresses how smart insulin pens represent one of many newer digital diabetes management tools that can assist people with diabetes and their clinicians to optimally achieve and deliver quality, data-driven diabetes care.ConclusionsNewer and simplified insulin delivery devices with their integrated management systems, such as smart insulin pens, have the potential to minimize the challenges and complexities associated with insulin injection therapy while also providing people with diabetes and their clinicians more complete and integrated data in easily transmitted reports that support more efficient data analysis.

Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. Conclusion Managing diabetes during the stages and ages of life is chronically challenging and complex. Various types of support offered by health care providers, including diabetes care and education specialists and others in the person’s social support milieu, can positively affect emotional well-being. Health care providers should routinely assess their client’s social supports and refer the person with diabetes and/or their caregivers to evidence-based types of peer support mutually determined to be of most value. Diabetes care and education specialists should increase their awareness of opportunities to integrate the value of and referral to peer support in their counseling and to gain greater insight into the diabetes-lived experience.

Natural resistant starch has been consumed from a variety of carbohydrate-containing foods for centuries. Due to the discovery of potential health benefits of resistant starch, it is now being incorporated into a growing array of commonly consumed foods. Added resistant starch in the diet can help consumers increase their fiber intake. Nutritional professionals should explore the potential health benefits of resistant starch and gather ways to help consumers increase their intake to more closely achieve the fiber goals of the Dietary Guidelines.

Purpose To describe the evolving and expanding role of nurse practitioners (NPs) in providing diabetes medical nutrition therapy (MNT) as the United States faces epidemics of diabetes and obesity. Data Sources Scientific literature and reports from the public health, diabetes, and nutrition fields. Conclusions Although clinically effective for both prevention and treatment of diabetes, MNT is often underutilized. The majority of people with diabetes are cared for by primary care providers; the role of NPs as primary care providers is evolving and expanding. NPs are recognized as leaders who creatively adapt to the rapidly changing health care delivery system. Implications for Practice NPs can serve as role models by presenting accurate, basic nutrition messages, referring patients to registered dietitians for MNT, reinforcing nutrition and the importance of lifestyle change as primary treatments for their disease, and following up on their patients' progress with nutrition interventions.

Numerous advances in diabetes management and medical nutrition therapy (MNT) for individuals with diabetes make this an exciting time. Historically, a challenge to proving the benefit of MNT has been the lack of clinical and behavioral research. In recent years, however, evidence-based outcomes research that documents the clinical effectiveness of MNT in diabetes has been reported. The term “medical nutrition therapy” was introduced in 1994 by the American Dietetic Association to better articulate the nutrition therapy process. It is defined as the use of specific nutrition services to treat an illness, injury, or condition and involves two phases: 1 ) assessment of the nutritional status of the client and 2 ) treatment, which includes nutrition therapy, counseling, and the use of specialized nutrition supplements (1). MNT for diabetes incorporates a process that, when implemented correctly, includes: 1 ) an assessment of the patient’s nutrition and diabetes self-management knowledge and skills; 2 ) identification and negotiation of individually designed nutrition goals ; 3 ) nutrition intervention involving a careful match of both a meal-planning approach and educational materials to the patient’s needs, with flexibility in mind to have the plan be implemented by the patient; and 4) evaluation of outcomes and ongoing monitoring. These four steps are necessary to assist patients in acquiring and maintaining the knowledge, skills, attitudes, behaviors, and commitment to successfully meet the challenges of daily diabetes self-management (2). The primary purpose of this article is to review the evidence for the effectiveness of MNT in diabetes, both as an independent variable and in combination with other components of diabetes self-management training (DSMT). In addition, the recent studies that have demonstrated the effectiveness of lifestyle intervention, which included MNT, in preventing type 2 diabetes will be highlighted. Evidence from several studies that supports the cost-effectiveness of MNT in diabetes will also be …

The scientific literature demonstrates that fat replacers have a reasonable certainty of no harm. Whether they help produce desired health outcomes, i.e., decreased risk of coronary heart disease and certain types of cancer related to excess fat intake, weight reduction, changes in lipid profile, improved glycemic control, etc., depends on how individuals use these foods to change food choices and eating behaviors. As Miller and Rolls conclude, ...the use of fat-replaced foods alone should not be expected to produce spontaneous improvements in weight management. Such improvements will still be dependent on long-term behavioral changes that include not only modifications in fat, but also modifications in overall energy intake and increase in energy expenditure. (53) Though it has not been studied, one may conjecture that encouraging people with diabetes to use foods with fat replacers to achieve nutrition management goals requires sufficient education, continuous counseling, and an individual's conscientious commitment and readiness to change food habits.

Advocacy efforts conducted within the diabetes community during the past few years have contributed to improvements in diabetes care, increased funding for diabetes research, and reduced discrimination towards people with diabetes. Two significant victories in diabetes care have been the passage of legislation that increases Medicare coverage for diabetes self-management training (DSMT) and supplies and medical nutrition therapy (MNT) for diabetes and renal disease. In brief, the Balanced Budget Act of 1997 (effective since February 27, 2001) provides coverage for all people with diabetes, if eligible, to receive coverage for both diabetes supplies and DSMT. When Medicare beneficiaries with Part B coverage meet the specified eligibility criteria, the plan will cover the costs of up to 10 hours of initial training within a continuous 12-month period. The plan also covers 2 hours of follow-up training per year thereafter for those eligible.1 In 2000, as part of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Congress created The Medical Nutrition Therapy Benefit (effective since January 1, 2002) for Medicare Part B beneficiaries with diabetes and renal disease. The diabetes MNT benefit consists of a maximum of 3 hours of MNT services in the 12-month period beginning with the initial assessment (episode of care) and 2 hours per year in subsequent years. Additional hours of MNT services may be covered within …