Outpatient Management of Diabetes Mellitus with Patient Education to Increase Dietary Carbohydrate and Fiber

The impact of patient education on dietary fiber intake, diabetes control, and serum lipids was examined in patients with non-insulin-dependent diabetes mellitus. Customary outpatient personnel and procedures were used to teach three diet plans: (1) the American Diabetes Association (ADA) diet, (2) the ADA diet modified to increase high-fiber, high-carbohydrate foods (IF), and (3) the IF diet supplemented with oat bran (IFOB). A control group was instructed on foot care to provide teaching visits. Fifty-two patients were recruited from an outpatient clinic and studied over a 6-wk period. Subjects were of low socioeconomic status and had completed a mean of 8.3 yr of education. Patients instructed to increase their intake of high-fiber foods reported a doubling of fiber intake and tolerated the diets well. Increased fiber and carbohydrate intake and decreased fat intake were associated with reductions in fasting plasma glucose levels. Increased fiber intake was also associated with reductions in total serum cholesterol and high-density lipoprotein cholesterol levels. Changes in fiber, carbohydrate, and fat intake were unrelated to changes in weight, serum insulin levels, or hemoglobin A_1c levels over the study period.