Newest Vital Sign: Questions to Ask (Health Literacy Part IV)

9/3/2012

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Questions to Ask for Newest Vital Sign http://farm3.static.flickr.com/2622/
The Newest Vital Sign developed by Pfizer along with experts of the University of Arizona College of Medicine. The NVS is designed as a questionnaire with a picture of a Nutrition Label at the back of a pint of ice cream. Patients are asked to interpret what it is.

See Picture of the Nutrition Label used for the test.

The questions asked are the following:

  1. If you eat the entire container, how many calories will you eat? 
  2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream would you have?
  3. Your doctor advises you to reduce the amount of staturated fat in your diet. you usually have 42 grams of saturated fact each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams saturated fat would you be consuming each day?
  4. If you usually eat 2500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving?


The right answers to these questions should be the following

For the first question: 1000

For the second question: Any of the following is correct---1 cup (or any amount up to 1 cup), half the container. (Be sure to clarify if the patient answers "two serving". Ask "How much ice cream would that be if you were to measure it into a bowl?")

For the Third question: 33

For the fourth question: 10%


Once you are through with these four questions, read to the patient or subject the following:

Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings.

5. Is it safe for you to eat this ice cream?

6. (Ask only if the patient responds "no" to question 5): Why not?

The fifth question should have a "No" answer to qualify as correct.

Lastly, the sixth question should have a correct answer similar to "because it has peanut oil".


Tally the number of correct answers.

Scores of 0-1 suggests high likelihood (50% or more) of limited literacy.
Scores of 2-3 indicates the possibility of limited literacy.
Scores of 4-6 almost always indicates adequate literacy.






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Nip the Bud: Preventing Diabetes

9/3/2012

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More Ways Than One (Photo by: Josh Mahoney)



























Can we really prevent diabetes? My cousin is one we rightly call the “Sweeper” because he is the last man out of the table after meals. He can finish just about everything that is left on the table as long as it is edible.

Regularly, we check his blood sugar and (surprise, surprise) he is way below the threshold for diabetes.

Even those in the medical profession have diabetes. I am most likely to get it with my strong family history, sedentary lifestyle and propensity to de-stress with bingeing. My cousin though, even if he keeps not just his own plate clean, is an avid walker. He walks daily to and from work and just about anywhere he can.

Can we really prevent diabetes? The latest study from the Diabetes Prevention Program Outcomes Study (DPPOS) may hold the answer. The study is a randomized controlled trial that compares long-term diabetes risk of those who achieve normal glucose control (defined as having fasting blood plasma glucose level of less than 100mg/dL and a 2-hour plasma glucose level of less than 140mg/dL) during the Diabetes Prevention Program with those who actually diabetes already that remains uncontrolled.

The study observed the incidence of diabetes and grouped the participants according to their medications and treatment.  Insulin secretion of the subjects and their sensitivity to insulin during the study was also observed.

Remarkable findings of this on-going observational study was numerous and interesting. If a participant achieved normal glucose regulation at least once during the Program, risk for progression to diabetes was reduced to 56%. When a participant achieves normal glucose regulation twice the risk reduction increases to 61% and further increased to 67% if the number of glucose regulation occurs thrice.

These findings point to tweak in our understanding of primary and secondary prevention of diabetes. This research clearly points out that diabetes is preventable and can be further delayed even with attainment of just once instance of normal glucose regulation.

The authors point to one plausible explanation for this significant reduction in diabetes risk which is related to the concept of “beta-cell rest”. Beta cells in the pancreas produce insulin needed to transport blood sugar (glucose) across all cells in need of energy to survive. With the volume of blood sugar in persons with diabetes, the beta cells may have long been exhausted or even depleted. Reaching normal levels, even for brief periods, provide them with the opportunity to “rest” their exhausted beta cells.

In contrast, some point to insulin insensitivity of the receiving cells as a reason why glucose remains in the blood stream instead of going in the cells. This research weighs in on the benefit of rest rather than on insensitivity of cells.

Therefore, it is best that once people who are diagnosed with diabetes should be treated aggressively just so they achieve this window of opportunity for reversing the progression of diabetes just by having “beta-cell rests” once, twice or continually.

Let us all have a wonderful and healthy life ahead! Let us rest our beta-cells and not just sit around moribund.

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