Sorry to sound sceptical, but could you explain what you mean when you say you are an 'an advanced diabetic educator'? What actual qualifications and experience do you have? What 'dissertation' are you doing and where are you doing it? What are the 'many articles' that you have read? How many of these are in proper medical journals (as opposed to 'the Harvard Gazette')?
So much of what you write begs so many questions -- 'normal range', 'acceptable range', 'hba1c goals' -- and you don't make any allusion to the role that certain foodstuffs have in generating food cravings ('diet compliance' is not just down to 'attitudes').
This is an advance practice registered nurse with a master's degree certificate and certification in diabetes management & treatment. I have certification in diabetic education and will be completing the MSN soon. I am working on the second phase which will allow the certification and training of other advanced practice nurses to learn and be certified as diabetic educator. I have been working in the diabetic educator field for 25 years after becoming a diabetic myself, and over the past 5 years I have concentrated on diabetic research and education looking for approaches to education and treatment that REALLY work. I joined the military in 1972 and eventually worked as a medical laboratory specialist for some time in the US Army. During that time I was working on my BSN.
Normal range means a laboratory value that is present in a healthy individual. Example: The
normal range for the HbA1c lab test is between 4% and 5.6%.
Acceptable range means the closer to the normal range, and I have been taught to keep it lower than 7. When I asked about why 7, the instructors reminded me that not all people have the ability to pull the number lower than 7. After 7 the blood glucose reaches that hyperglycemic state which we all must avoid.
HbA1c goals - these are goals that each individual sets in the mission center; for instance if we are seeing a 7.6% in the HbA1c, we might try to reach 7% or lower over a six week period.
I find it odd that not all people have food cravings in the population I serve. I have noticed for myself that the more carbs I consume, the more I crave food period. Carbs just do not satisfy my hunger. Lower glycemic vegetables (especially raw), a 3 oz chicken medallion, and lentils or beans fill my urges.
Dietary compliance can only be based on the success of that developed dietary plan which lowers the HbA1c labs, maintains that blood glucose within range, and most important, creates satiety, and an overall good feeling and energetic state for the patient. It is my own failure to not identify the correct approach to dietary intake that can place a patient in that state so that remaining on that regimen is not questioned by the patient or no laboratory value. I have seen this happen time and time again, however, I always wonder where I went wrong with those I fail.
The Harvard Gazette is published through Harvard Medical School, however, I do not use this in my research. Here are a few I reviewed this past week:
Bagnasco, A., Giacomo, P. D., Della Mora, R., Catania, G. Turci, C., Rocco, G. & Sasso, L. (2013). Research protocol: Factors influencing self-management in patients with type 2 diabetes: A quantitative systematic review protocol.
Journal of Advance Nursing, 70(1), 187-200. doi: 10.1111/jan.12178
Diabetes.co.uk (2013, Dec 9). Low adherence to diet and exercise changes in type 2 diabetes.
Diabetic News. Retrieved from
http://www.diabetes.co.uk/news/2013/Dec/low- adherence-to-diet-and-exercise-changes-in-type-2-diabetes-02050840.html
Garcia-Pérez, L., Alvarez, M., Dilla, T., Fil-Gullén & Orozco-Beltrán, D. (2013, Dec). Adherence to therapies in patients with type 2 diabetes.
Diabetes Therapy, 4(2), 175-194. doi: 10.1007/st3300-013-0034-y
Halali, F., Mahdavi, R., Mobasseri, M., Jafarabadi, M. A. & Avval, S. K. (2016). Perceived barriers to recommended dietary adherence in patient with type 2 diabetes in Iran
. Journal of Eating Behaviors, 21, 205-210. doi: 10.1016/j.eatbeh.2015.03.001
Koenigsberg, M. R., Bartlett, D. & Cramer, J. S. (2004 Jan 15). Facilitating treatment adherence with lifestyle changes in diabetes.
American Family Physicians, 69(2), 309-316. Retrieved from
http://www.aafp.org/af
LaCroix, S. (2015, Aug 11). Are you in diabetes denial? Why it is dangerous to ignore your diagnosis.
Safebee. Retrieved from
www.safebee.com/health/are-you-diabetes-denial
Linde, R. (2016). Diabetes risk management.
The Doctors Company. Retrieved from
http://www.thedoctors.com/KnowledgeCenter/PatientSafety/articles/Diabetes-Risk- Management
Masters, K. (2015). The health promotion model: Overview of Pender’s health promotion model,
Nursing Theories: A Framework for Professional Practice (pp. 215). Burlington: Jones & Bartlett Learning.
Mohammed, O. M. I., & Hassanein, M., (2016). Can structured education improve metabolic outcome and quality of life in diabetes? A systematic review of randomized controlled trials.
Middle East Journal of Family Medicine, 14(2), 31-43. Retrieved from
http://eds.a.ebscohost.com.ezproxy.uttyler.edu:2048/eds/pdfviewer/pdfviewer?sid=4a76b eb5-6a12-463b-8afd-42043d756d6e@sessionmgr4005&vid=2&hid=4108
Nam, S., Chesla, C., Stotts, N., Kroon, L. & Janson, S. (2011). Barriers to diabetes management: Patient and provider factors.
Diabetic Research and Clinical Practice, 93(1), 1-9. doi: 10.1016/j.diabres.2011.02.002.Epub 2011 Mar 5
Pender, N.J., Murdaugh, C. & Parsons, M.A. (2016). Interventions for health promotion and prevention.
Health Promotion in Nursing Practice (pp. 157 – 163). Boston: Pearson.
Shrivasta, S. R., Shrivasta, P. S. & Ramasamy, J. (2013, Dec) Role of self-care in management of diabetes mellitus.
Journal of Diabetes & Metabolic Disorders, 12(14). doi: 10.1186/2251-6581-12-14
I hope that I have answered your questions.