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PP170-SUN MOTIVATIONAL INTERVIEWING IN RURAL AREA CLINICS TO ENHANCE ADHERENCE IN DIABETICS (MIRACLE AID PROJECT): COMMUNITY BASED RETROSPECTIVE STUDY
Nutrition and chronic diseases I to be a cause of crystalline damage with consequent cataract development. Data from observational suggest a protective role of dietary antioxidants and/or supplements. In patients referred to cataract surgery, we aimed: (1) to assess the diet intake of sugar and antioxidants (vitamins A, C, E, magnesium and zinc); (2) to correlate those nutrients with the timing of cataract onset. Methods: In this pilot study comprising 99 cataract pts, dietary intake was assessed through a 24-hr recall food questionnaire, converted into nutrients using the Portuguese Food Composition Table® . Median intakes were compared with Dietary Reference Intakes (DRIs). Statistics: descriptive, independent samples Student’s t-test, Spearman’s correlations. Results: Patient distribution was 53F;46M, mean age 66 (42 80 yrs). Overall there was an excessive sugar intake vs the DRI (p = 0.0001). In what concerns antioxidants, patients had a low intake of: vit A (females: median = 513 mg; males: median = 465 mg, p = 0.003), vit E (females: median = 9.2 mg; males: median = 11.4 mg, p = 0.007), magnesium (females: median = 259 mg; males: median = 337.5 mg, p = 0.01) and zinc (females: median = 7.4 mg; males: median = 9.5, NS). Higher intake of vit A, lower intake of simple sugars and low diet glycemic index were associated with later cataract onset, p < 0.005. Conclusion: There was an overall unbalanced and poor diet in this cohort, with excessive sugar intake concomitantly with reduced intake of vitamins A, E, magnesium and zinc. As a major Public Health issue, more studies about the actual role of the dietary pattern in increasing the risk of cataract are necessary to promote health policies and nutrition care, which may contribute to reduce the incidence of this central cause of blindness worldwide. Disclosure of Interest: None Declared.
PP170-SUN MOTIVATIONAL INTERVIEWING IN RURAL AREA CLINICS TO ENHANCE ADHERENCE IN DIABETICS (MIRACLE AID PROJECT): COMMUNITY BASED RETROSPECTIVE STUDY E. Merzon1 , M. Shpigelman2 , E. Kitai1 , M. Gross2 , A. Golan-Cohen1 . 1 Tel Aviv University, Department of Family Medicine, 2 Leumit Health Services, Ariel, Israel Rationale: Achieving good glycaemic control is strongly dependent on patient’s adherence to treatment. Patients discontinue therapy for reasons that include side effects and lack of understanding and appreciation of the benefits of therapy. Underserved populations especially immigrants and older adults, living in the rural and remote area need special attention to enhance their adherence. Motivational Interviewing (MI) is a patientcentered counseling approach that actively engages patients in changing health behavior. Methods: Our retrospective study was conducted in two rural area clinics of Leumit Health Services, with the same average number of diabetic patients per primary care physician. The aim was to evaluate whether the short training of primary care team in culturally adapted motivational interviewing (CAMI) will improve quality indicator outcomes in diabetes care, as compared with traditional paternalistic approach.
93 Results: The proportion of uncontrolled diabetic patients (HbA1c > 9) was significantly lower in the clinic receiving CAMI intervention as compared to control clinic): 6.8% vs. 18% (p < 0.01). The proportion of patients with optimal blood pressure (<130/80) and optimal LDL level was also significantly higher in the clinic receiving CAMI intervention: 92.6%vs. 70.8% (p < 0.01) and 66.9% vs. 58.3% (p < 0.01) respectively. Among uncontrolled diabetic patients or diabetic patients with microalbuminuria adherence to insulin treatment or to ACEI’s/ARB’s medications was also higher in CAMI intervention clinic 58.3% vs. 46.2% (p < 0.01) and 91.6% vs. 80.9% (p < 0.05) respectively. Conclusion: Short training of primary care team in culturally adapted motivational interviewing (CAMI) helps to improve diabetes quality indicators. Disclosure of Interest: None Declared.
PP171-SUN INTRADIALYTIC PARENTERAL NUTRITION IN CHRONIC HEMODIALYSIS PATIENTS A. Ayucar Ruiz de Galarreta1 , M.J. Garcia Monje2 , F. Pita3 , G. Lugo3 , L. Cordero2 , M. Mourelo2 , A.I. Suarez2 . 1 Nutritional Support Unit, 2 Intensive Care Medicine, 3 Endocrinology, A Coru˜ na University Hospital, A Coru˜ na, Spain Rationale: Patients on chronic hemodialysis (CHD) have a high incidence of malnutrition, which is one of the strongest predictors of mortality and morbidity in this population. Methods: Prospective, observational study from 2005 to 2011. Monthly Nutritional Status was assess by a dietary survey, biochemical parameters, Inflammatory State (CRP) and Body Mass Index (BMI). Patients with more than 3 Lazarus criteria started nutritional support (NS). CHD patients without malnutrition (control group), and malnourished candidates to IDPN (study group). Our objectives were to evaluate the nutritional status of CHD patients and determine IDPN efficiency. Results: 108 patients and 38 controls, 52.7% men, mean age 59.20±17 in study group and 63.6±17.3 in controls (ns). Nutrition time was 3.69±4.4 months (1 12m) (MDNA 2.0), nutritional intake of 42±49.5 (MDNA = 24). Albumin increased during treatment (significance oscillating between 0.000 and p = 0.03), transferrin (p = 0.008 and 0.05), prealbumin (p = 0.01) and Fe (p = 0.000 and 0.001). 59 patients were admitted to the hospital, and received IDPN. Mean duration of NS was 2.28±2.24 m vs. 5.41±5.7 m (p = 0.003) in those not admitted. Admitted presented lower nutritional parameters and CRP higher before IDPN. Both subgroups improved with IDPN, mainly those not admitted. 39% patients died in the study group. Patients who died had lower albumin (2.6±0.63, vs. 2.73±0.63), total lymphocytes (1056±536 vs. 1203±764) and higher CRP (4.9±6.7 vs 1.8±2.18) (ns). Conclusions: 1. IDPN in CHD malnourished patients shows improvement in nutritional parameters. 2. Malnourished patients with higher inflammatory state suffer more complications requiring hospitalization.
PP170-SUN MOTIVATIONAL INTERVIEWING IN RURAL AREA CLINICS TO ENHANCE ADHERENCE IN DIABETICS (MIRACLE AID PROJECT): COMMUNITY BASED RETROSPECTIVE STUDY E. Merzon1 , M. Shpigelman2 , E. Kitai1 , M. Gross2 , A. Golan-Cohen1 . 1 Tel Aviv University, Department of Family Medicine, 2 Leumit Health Services, Ariel, Israel Rationale: Achieving good glycaemic control is strongly dependent on patient’s adherence to treatment. Patients discontinue therapy for reasons that include side effects and lack of understanding and appreciation of the benefits of therapy. Underserved populations especially immigrants and older adults, living in the rural and remote area need special attention to enhance their adherence. Motivational Interviewing (MI) is a patientcentered counseling approach that actively engages patients in changing health behavior. Methods: Our retrospective study was conducted in two rural area clinics of Leumit Health Services, with the same average number of diabetic patients per primary care physician. The aim was to evaluate whether the short training of primary care team in culturally adapted motivational interviewing (CAMI) will improve quality indicator outcomes in diabetes care, as compared with traditional paternalistic approach.
93 Results: The proportion of uncontrolled diabetic patients (HbA1c > 9) was significantly lower in the clinic receiving CAMI intervention as compared to control clinic): 6.8% vs. 18% (p < 0.01). The proportion of patients with optimal blood pressure (<130/80) and optimal LDL level was also significantly higher in the clinic receiving CAMI intervention: 92.6%vs. 70.8% (p < 0.01) and 66.9% vs. 58.3% (p < 0.01) respectively. Among uncontrolled diabetic patients or diabetic patients with microalbuminuria adherence to insulin treatment or to ACEI’s/ARB’s medications was also higher in CAMI intervention clinic 58.3% vs. 46.2% (p < 0.01) and 91.6% vs. 80.9% (p < 0.05) respectively. Conclusion: Short training of primary care team in culturally adapted motivational interviewing (CAMI) helps to improve diabetes quality indicators. Disclosure of Interest: None Declared.
PP171-SUN INTRADIALYTIC PARENTERAL NUTRITION IN CHRONIC HEMODIALYSIS PATIENTS A. Ayucar Ruiz de Galarreta1 , M.J. Garcia Monje2 , F. Pita3 , G. Lugo3 , L. Cordero2 , M. Mourelo2 , A.I. Suarez2 . 1 Nutritional Support Unit, 2 Intensive Care Medicine, 3 Endocrinology, A Coru˜ na University Hospital, A Coru˜ na, Spain Rationale: Patients on chronic hemodialysis (CHD) have a high incidence of malnutrition, which is one of the strongest predictors of mortality and morbidity in this population. Methods: Prospective, observational study from 2005 to 2011. Monthly Nutritional Status was assess by a dietary survey, biochemical parameters, Inflammatory State (CRP) and Body Mass Index (BMI). Patients with more than 3 Lazarus criteria started nutritional support (NS). CHD patients without malnutrition (control group), and malnourished candidates to IDPN (study group). Our objectives were to evaluate the nutritional status of CHD patients and determine IDPN efficiency. Results: 108 patients and 38 controls, 52.7% men, mean age 59.20±17 in study group and 63.6±17.3 in controls (ns). Nutrition time was 3.69±4.4 months (1 12m) (MDNA 2.0), nutritional intake of 42±49.5 (MDNA = 24). Albumin increased during treatment (significance oscillating between 0.000 and p = 0.03), transferrin (p = 0.008 and 0.05), prealbumin (p = 0.01) and Fe (p = 0.000 and 0.001). 59 patients were admitted to the hospital, and received IDPN. Mean duration of NS was 2.28±2.24 m vs. 5.41±5.7 m (p = 0.003) in those not admitted. Admitted presented lower nutritional parameters and CRP higher before IDPN. Both subgroups improved with IDPN, mainly those not admitted. 39% patients died in the study group. Patients who died had lower albumin (2.6±0.63, vs. 2.73±0.63), total lymphocytes (1056±536 vs. 1203±764) and higher CRP (4.9±6.7 vs 1.8±2.18) (ns). Conclusions: 1. IDPN in CHD malnourished patients shows improvement in nutritional parameters. 2. Malnourished patients with higher inflammatory state suffer more complications requiring hospitalization.