RESPONSE DISCUSSION

Type 2 diabetes mellitus (T2DM) is associated with many complications. Complications can include heart disease, stroke, kidney failure, blindness, and increased infection susceptibility (Kramer et al., 2007). According to Levensky et al. (2007), interventions that improved the quality of a diabetic patient’s diet have demonstrated effectiveness in controlling hyperglycemia, thus reducing the risk of diabetes-associated complications. Soluble dietary fiber has been shown to reduce glucose levels in diabetic patients (Sierra et al.,2002). Dietary fiber is widely prescribed to reduce cholesterol levels (NCEP, 2002). However, there is a lack of research devoted to Primary Care Nurse Practitioner interventions to support the beneficial effects of dietary fiber intake in patients with type 2 diabetes mellitus.

Motivational interviewing (MI) is a patient‐centered, directive counseling technique that focuses on assisting patients in identifying their problems and overcoming ambivalence and resistance to behavior change (Miller and Rollnick, 2002). MI has shown success in improving patient adherence to a treatment plan. A meta analysis by Rubak and colleagues found that motivational interviewing works better than simply giving advice in a broad range of diseases. Using MI's therapeutic skills : reflective listening, asking open questions, affirming and summarizing, and patients become true partners in their treatment plans (Miller and Rollnick, 2002). Using the four basic skills of MI to increase the patient’s fiber intake, the Nurse Practitioner (NP) could improve blood sugars, lipid control and decrease overall complications of T2DM.

References:

Chen, C., Zeng, Y., Xu, J., Zheng, H., Liu, J., Fan, R., ... & Wang, J. (2016). Therapeutic effects of soluble dietary fiber consumption on type 2 diabetes mellitus. Experimental and therapeutic medicine, 12(2), 1232-1242.

Kramer, CK, Leitão, CB., Pinto, LC., Boza, J., Silveiro, SP., Gross, JL., & Canani, LH., (2009). Risk factors for micro and macrovascular disease in black and white patients with type 2 Diabetes mellitus Comparação de fatores de risco para complicações micro e macrovasculares em pacientes com Diabetes mellitus tipo 2 negros e brancos. Revista Da Associação Médica Brasileira, 55(3), 308–314. https://doi-org.ezp.waldenulibrary.org/10.1590/S0104-42302009000300024

Levensky, E. R., Forcehimes, A., O’Donohue, W. T., & Beitz, K. (2007). Motivational interviewing: An evidence-based approach to counselling helps patients follow treatment recommendations. American Journal of Nursing, 107(10), 50–58.

Miller WR, Rollnick S, editors. Motivational interviewing: preparing people for change. 2nd ed. New York: Guilford Press; 2002.

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. (2002). Circulation, 106(25), 3143–3421.

Pimentel, G. D., Arimura, S. T., de Moura, B. M., Silva, M. E. R., & de Sousa, M. V. (2010). Short-term nutritional counseling reduces body mass index, waist circumference, triceps skinfold and triglycerides in women with metabolic syndrome. Diabetology & Metabolic Syndrome, 2(1), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/1758-5996-2-13

Rubak, S., Sandboek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. BRITISH JOURNAL OF GENERAL PRACTICE, 55(513), 305–312.

Sierra, M., García, J. J., Fernández, N., Diez, M. J., & Calle, A. P. (2002). Therapeutic effects of psyllium in type 2 diabetic patients. European journal of clinical nutrition, 56(9), 830-842.