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Health SA Gesondheid (Online)

versão On-line ISSN 1025-9848

Health SA Gesondheid (Online) vol.14 no.1 Cape Town  2009

 

REVIEW ARTICLE

 

Elements of effective nutrition education for adults with diabetes mellitus in resource-poor settings: A review

 

 

Jane W. MuchiriI; Gerda GerickeI; Paul RheederII

IDepartment of Human Nutrition, University of Pretoria, South Africa
IIDivision of Clinical Epidemiology, University of Pretoria, South Africa

Correspondence

 

 


ABSTRACT

This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings.
Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes, which include appropriate change in dietary behaviour, improved glycaemic control, plasma lipid levels, blood pressure and body weight, as well as improved potential mediators (knowledge, skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs, abilities and socio-cultural context of the target group, the active involvement of the patient, a behaviour-focused approach based on appropriate theory, suitable delivery methods and individual/group approaches. Adequate contact time with an educator (> 10 hours), the educator's competence, provision of social support and follow-up intervention are also crucial.
Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs.

Keywords: type 2 diabetes; low-income; nutrition education; effectiveness; self-management education


OPSOMMING

Hierdie artikel beklemtoon die sleutelfaktore wat in oorweging geneem moet word wanneer 'n ef-fektiewe voedingsopleidingprogram vir volwassenes met tipe 2-diabetes uit hulpbron-arm agter-gronde beplan word.
Tipe 2-diabetes is besig om globaal tot epidemiese vlakke toe te neem. Lae sosio-ekonomiese status word geassosieer met swakker gesondheidsresultate en 'n hoër ekonomiese las. Dieetnakoming word deur persone met diabetes as die moeilikste selfversorgingsgebied uitgewys.
Doeltreffende voedingsopleiding bereik die gewenste doelwitte en resultate wat toepaslike veranderings in dieetgedrag, verbeterde glisemiese beheer, verbeterde bloedlipiede, bloeddruk en liggaams-gewig, en verbeterde potensiële bemiddelaars (kennis, vaardighede en houdings), insluit. Elemente wat tot 'n suksesvolle voedingsopleidingprogram bydra, sluit ingrypings in wat geskoei is op die behoeftes, vaardighede en sosiaal-kulturele konteks van die teikengroep, aktiewe betrekking van die pasient, gebruik van 'n benadering wat ingestel is op gedrag en gegrond is op toepaslike teorie, toepaslike metodes van aflewering en individuele/groepbenaderings, geskikte duur en kontaktyd (> 10 uur), een wat vir sosiale ondersteuning en opvolgintervensie sorg, en deur 'n bedrewe verskaffer bemiddel word.

Om diabetiese individue uit hulpbron-arm agtergronde op te lei in voeding is 'n uitdagende taak wat vindingryke en bedrewe opvoeders verg. Hierdie opvoeders moet sensitief wees vir die unieke behoeftes van die teikengroep en toepaslike benaderings volg om genoemde behoeftes aan te spreek.


 

 

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References

ADA (American Diabetes Association), 2007a, 'Clinical practice recommendations; Standards of medical care', Diabetes Care 30(suppl. 1), S4-S41.         [ Links ]

ADA (American Diabetes Association), 2007b, 'Nutrition recommendations and interventions for diabetes: A position statement', Diabetes Care 30(suppl. 1), S48-S65.         [ Links ]

Adamson, A.J. & Mathers, J.C., 2004, 'Effecting dietary change', Proceedings of the Nutrition Society 63, 537-547.         [ Links ]

Anderson, R.M. & Funnel, M.M., 2000, 'Compliance and adherence are dysfunctional concepts in diabetes care', Diabetes Educator, 26(4), 597-604.         [ Links ]

Anderson, R.M., Funnell, M.M. & Hernandez, C.A., 2005, 'Choosing and using theory in diabetes education research', Diabetes Educator 31(4), 513-520.         [ Links ]

Anderson-Loftin, W., Barnett, S., Sullivan, P., Bunn, P.S., Tavakoli, A., 2002, 'Culturally competent dietary education for southern rural African Americans', Diabetes Educator 28(2), 245-257.         [ Links ]

Anderson-Loftin, W., Barnett, S., Bunn, P., Sullivan, P., Hussey, J., Tavakoli, A., 2005, 'Soul food light: Culturally competent diabetes education', Diabetes Educator 31(4), 555-563.         [ Links ]

Asha, A., Pradeepa, R. & Mohan, V., 2004, 'Evidence for benefits from diabetes education programs', International Journal of Diabetes in Developing Countries 24(4), 96-102.         [ Links ]

Bandura, A., 2004, 'Health promotion by social cognitive means', Health Education and Behaviour 31(2), 143-146.         [ Links ]

Banister, N.A., Jastro, S.T., Hodges, V., Gillham, B., 2004, 'Diabetes self-management training program in a community clinic improves patient outcomes at modest cost', Journal of the American Dietetic Association 104(5), 807-810.         [ Links ]

Bell, R.A., Camacho, F., Goonan, K., Duren-Winfiel, V., Anderson, R.T., Konen, J.C & Goff, D.C., 2001, 'Quality of diabetes care among low-income patients in North Carolina', American Journal of Preventive Medicine 21(2), 124-131.         [ Links ]

Benavides-Vaello, S., Garci, A.A., Brown, S.A & Winchell, M., 2004, 'Using focus groups to plan and evaluate diabetes self-management interventions for Mexican Americans', Diabetes Educator 30(2), 238-256.         [ Links ]

Betts, N.M.,Baranowski, T. & Hoerr, S.L., 1996, 'Recommendations for planning and reporting focus group research', Journal of Nutrition Education 28(5), 279-281.         [ Links ]

Blanchard, M.A., Rose, L.E., Taylor, J., McEntee, M.A., Latchaw, L.L., 1999, 'Using focus groups to design a diabetes education program for an African American population', Diabetes Educator 25(6), 917-925.         [ Links ]

Brown, S.A., 1999, 'Interventions to promote diabetes self-management: State of art science', Diabetes Educator 25(6), S52-S61.         [ Links ]

Brown, S.A. & Hanis, C.L., 1999, 'Culturally competent diabetes education for Mexican Americans: The Starr County Study', Diabetes Educator 25(2), 226-236.         [ Links ]

Brown, S.A., Kouzekanani, K., Garcia, A.A. & Hanis, C.L., 2002, 'Culturally competent diabetes self-management education for Mexican Americans: The Starr Border Health Initiative', Diabetes Care 25(2), 259-268.         [ Links ]

Brown, S.A., Garcia, A.A. & Winchell, M., 2002, 'Reaching the under-served populations and cultural competence in diabetes education', Current Diabetes Reports 2, 166-176.         [ Links ]

Brown, S.A., Garcia, A.A., Blozis, S.S., Winchell, M., Kouzekanani, K. & Hanis, C.L., 2005, 'Dosage effects of diabetes self-management education for Mexican Americans: The Starr County Border Health Initiative', Diabetes Care 28(3), 527-532.         [ Links ]

Camelon, K.M., Handell, K., Jamsen, P.T., Ketonen, K.J., Kohtamaki, H.M., Makimatilla, S., Tormala, M & Valve, R.H., 1998, 'The plate model: A visual method of teaching meal planning', Journal of the American Dietetic Association 98(10), 1155-1158.         [ Links ]

Campbell, E.M., Redman, S., Moffitt, P.S. & Sanson-Fisher, R.W., 1996, 'The relative effectiveness of educational and behavioural instruction programs for patients with NIDDM: A randomised trial', Diabetes Educator 22(4), 379-386.         [ Links ]

Chapman, K.M., Ham, J.O., Liesen, P. & Winter, L. ,1995, 'Applying behavioural models to dietary education of elderly diabetic patients', Journal of Nutrition Education 25, 75-79.         [ Links ]

Chin, M.H., Zhang, J.X. & Merrell, K., 1998, 'Diabetes in the African-American Medicare population: Morbidity, quality of care and resource utilization', Diabetes Care 21(7), 1090-1095.         [ Links ]

Clark, M., 2002, 'Lifestyle self-management in patients with type 2 diabetes', Journal of Diabetes Nursing 6(6), 182-187.         [ Links ]

Clement, C., 1995, 'Diabetes self-management education', Diabetes Care 18(8), 1204-1214.         [ Links ]

Contento, I.R., Bronner, Y.L., Swadener, S.S., Lytle, L.A., Maloney, S.K., Olson, C.M., Balch, G.I., 1995, 'The effectiveness of nutrition education and implications for nutrition education policy programs and research: A review of research', Journal of Nutrition Education 27(6), 277-422.         [ Links ]

Contento, I.R., Randell, J.S. & Basch, C.E., 2002, 'Review and analysis of evaluation measures used in nutrition education intervention research', Journal of Nutrition Education and Behaviour 34, 2-25.         [ Links ]

Corkery, E., Palmer, C., Foley, M.E., Schetchter, C.B., Frisher, L. & Roman, S.H., 1997, 'Effect of a bicultural community health worker on the completion of diabetes education in a Hispanic population', Diabetes Care 20(3), 254-257.         [ Links ]

Cox, R.H., Carpenter, J., Bruce, S.A., Poole, K.P. & Gaylord, C.K., 2004, 'Characteristics of low-income African-American and Caucasian adults that are important in self-management of type 2 diabetes', Journal of Community Health 29(2), 155-170.         [ Links ]

Day, J.L., 2000, 'Diabetic patient education: Determinants of success', Diabetes Metabolism Research and Reviews 16 (suppl. 1), S70-S74.         [ Links ]

Eakin, E.G., Bull, S.S., Glasgow, L.E. & Mason, M., 2002, 'Reaching those most in need: A review of diabetes self-management interventions in disadvantaged populations', Diabetes Metabolism Research and Reviews 18, 26-35.         [ Links ]

Elasy, T.E., Ellis, S.E., Brown, A. & Pichert, J.W., 2001, 'Taxonomy for diabetes educational interventions', Patient Education and Counseling 43, 121-127.         [ Links ]

Ellis, E.E., Speroff, T., Dittus, R.S., Brown, A., Pichert, J.W. & Elasy, T.A., 2004, 'Diabetes patient education: A meta-analysis and meta-regression', Patient Education and Counseling 52, 97-105.         [ Links ]

Fischer, L.F. & Glasgow, R.E., 2007, 'A call for more effectively integrating behavioural and social science principles into comprehensive diabetes care', Diabetes Care 30(10), 2746-2749.         [ Links ]

Franz, M.J., 2004, 'Medical nutrition therapy for diabetes mellitus and hypoglycaemia of non-diabetic origin', in L.K. Mahan & S. Escott-Stump, Krause's food, nutrition and diet therapy, 11th edn., pp. 792-830, WB Saunders, Philadelphia.         [ Links ]

Franz, M.J., Warshaw, H., Daly, A.E., Pastors, J. & Bantle, J., 2003, 'Evolution of diabetes medical nutrition therapy', Postgraduate Medical Journal 79, 30-35.         [ Links ]

Franz, M.J., Monk, A., Barry, B., McClain, K., Weaver, T., Cooper, C., Upham, P., Bergenstal, R. & Mazze, R.S., 1995, 'Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin dependent diabetes mellitus: A randomised controlled trial', Journal of the American Dietetic Association 95, 1009-1017.         [ Links ]

Funnell, M.M., M.M., Brown, T.L., Childs, B.P., Haas, L.B., Hosey, G.M., Jensen, B., Maryniuk, M., Peyrot, M., Piette, J.D., Reader, D., Siminerio, L.M., Weinger, K. & Weiss, M.A., 2008, 'National standards for diabetes self-management education', Diabetes Care 31(suppl. 1), S97-S104.         [ Links ]

Gagliardino, J.J. & Etchegoyen, G.R., 2001, 'A model education program for type 2 diabetes: A co-operative Latin American implementation study (PEDNID-LA)', Diabetes Care 24(6), 1001-1007.         [ Links ]

Garcia, R. & Suarez, L., 1996, 'Diabetes education in the elderly: A 5-year follow-up of an interactive approach', Patient Education and Counseling 29(1), 87-97.         [ Links ]

Garret, N., Hageman, C.N., Sibley, S.D., Davern, M., Berger, M., Brunzell, C., Malecha, K & Richards, S.W., 2005, 'The effectiveness of an interactive small group diabetes intervention in improving knowledge, feeling of control and behaviour', Health Promotion and Practice 6(3), 320-328.         [ Links ]

Glasgow, R.E., Strycker, L.A., Hampson, S.E. & Ruggiero, L., 1997, 'Personal-model beliefs and social-environmental barriers related to diabetes self-management', Diabetes Care 20(4), 556-560.         [ Links ]

Glasgow, R.E., Toobert, D.J. & Hampson, J.F., 1996, 'Effects of a brief office based intervention to facilitate dietary self-management', Diabetes Care 19(8), 835-842.         [ Links ]

Glasgow, R.E., Lachance, P.A., Toobert, D., Hampson, S.E. & Riddle, M.C., 1997, 'Long term effects and cost of brief behavioural intervention for patients with diabetes delivered from the medical office', Patient Education and Counseling 32(3), 175-185.         [ Links ]

Glazier, R.H., Bajcar, J., Kennie, N.R. & Wilson, N.K., 2006, 'A systematic review of interventions to improve diabetes care in the socially disadvantaged populations', Diabetes Care 29(7), 1675-1688.         [ Links ]

Goldhaber-Fiebert, J.D., Tristan, M.L., Goldhaber, S.N. & Nathan, D.M., 2003, 'Randomised controlled community based nutrition and exercise intervention improves glycaemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica', Diabetes Care 26(1), 24-29.         [ Links ]

Hampton, K.K., Bodansky, H.J. & Stickland, M., 1998, 'Audit of an educational program for recently diagnosed type 2 diabetic patients', Practical Diabetes 15(6), 166-167.         [ Links ]

IDF (International Diabetes Federation-Clinical Guidelines Task Force), 2005, 'Global guidelines for type 2 diabetes: Lifestyle management', Chapter 5, pp. 22-25, viewed 22 August 2007 from http//www.idf.org/webdata/docs/GGT2D%2005%20 lifestyle%20management.pdf.         [ Links ]

Knight, K.M., Dornan, T. & Bundy, C., 2006, 'The diabetes educator: Trying hard, but must concentrate more on behaviour', Diabetic Medicine 23, 485-501.         [ Links ]

Kreuter, M.W. & Strecher, V.J., 1996, 'Do tailored behaviour change messages enhance the effectiveness of health risks appraisal: Results from a randomised trial', Health Education Research 11, 97-105.         [ Links ]

Lemon, C.C., Lacey, K., Lohse, B., Hubacher, D.O., Klawittter, B. & Palta, M., 2004, 'Outcomes monitoring of health, behaviour and quality of life after intervention in adults with type 2 diabetes', Journal of the American Dietetic Association 104, 1805-1815.         [ Links ]

Levetan, B.N., Levitt, N.S. & Bonnici, F., 1997, 'Hyperglycaemic emergencies are a common problem', South African Medical Journal 87, 368-370.         [ Links ]

Lorig, K., 2003, 'Self management education more than a nice extra', Medical Care 41(6), 699-701.         [ Links ]

Maldonato, A., Bloise, D., Ceci, M., Fraticelli, E. & Fallucca, F., 1995, 'Diabetes mellitus: Lessons from patient education', Patient Education and Counseling 26(1), 57-66.         [ Links ]

Mau, M.K., M.K., Grove, S.G., Johnson, B., Curb, J.D., Serivo, R. & Glanz, K., 2001, 'Mediators of lifestyle behaviour change in native Hawaiians', Diabetes Care 24(10), 1770-1773.         [ Links ]

McKenzie, J.F., Neiger, B.L. & Smeltzer, J.L., 2005, Planning, implementing and evaluating health promotion programs, 4th edn., pp. 72-83, 147-157, Pearson Education, San Francisco.         [ Links ]

Mensing, C.R., Ladichak, A., Lam, B., Mangan, M., Boucher, J., Cypress, M., Weinger, K., Mulcahy, K., Barta, P., Hosey, G., Kopher, W., Norman, J., Tanja, J., Yauk, L., Wisdom, K. & Adams, C., 2007, 'National standards for diabetes self-management education', Diabetes Care 30 (suppl. 1), S96-S103.         [ Links ]

Mensing, C.R. & Norris, S.L., 2003, 'Group education in diabetes: Effectiveness and implementation', Diabetes Spectrum 16(2), 96-103.         [ Links ]

Miller, C.K., Edwards, L., Kissling, G. & Sanville, L., 2002, 'Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: Results from a randomised controlled trial', Preventive Medicine 34(2), 252-259.         [ Links ]

Murphy, B., 2004, 'Health education and communication strategies', in H. Keleher & B. Murphy (eds.), Understanding health: A determinants approach, Oxford University Press, Melbourne.         [ Links ]

Narayan, K.M.V., Zhang, P., Williams, D., Engelgau, M.M., Imperatore, G., Kanaya, A. & Ramachandran, A., 2006, 'How should developing countries manage diabetes?' Canadian Medical Association Journal 175(5), 733-736.         [ Links ]

Narayan, K.M.V., Gregg E.W., Fagot-Campagna, A., Engelgau, M.M., Vinicor, F., 2000, 'Diabetes, a common, growing, serious, costly and potentially preventable public health problem', Diabetes Research and Clinical Practice 50(suppl. 2), S77-S84.         [ Links ]

Nestle, M., Wing, R., Birch, L., DiSogra, L., Drewnowski, A., Middletown, S., Sigman-Grant, M., Sobal, J., Winston, M. & Economos, C., 1998, 'Behavioural and social influences on food choice', Nutrition Reviews 56(5), S50-S74.         [ Links ]

Noel, P.H., Larme, A.C., Marsh, G., Correa, A. & Pugh, J.A., 1998, 'Patient education choice in diabetes curriculum: Nutritional versus standard content for type 2 diabetes', Diabetes Care 21(6), 896-901.         [ Links ]

Norris, S.L., Lau, J., Smith, S.J., Schmid, C.H. & Engelgau, M.M., 2002, 'Self-management education for adults with type 2 diabetes: A meta-analysis of effect on glycaemic control', Diabetes Care 25(7), 1159-1171.         [ Links ]

Norris, S.L., Engelgau, M.M. & Narayan, K.M.V., 2001, 'Effectiveness of self-management training in type 2 diabetes: A systematic review of randomised controlled trials', Diabetes Care 24(3), 561-587.         [ Links ]

PADA (Position of the American Dietetic Association), 1995, 'Cost effectiveness of medical nutrition therapy', Journal of the American Dietetics Association 95, 88-91.         [ Links ]

PADA (Position of the American Dietetic Association), 1996, 'Nutrition education for the public', Journal of the American Dietetic Association 96(11), 1183-1187.         [ Links ]

Pastors, J.G., Warshaw, H., Daly, A., Franz, M.J. & Kulkani, K., 2002, 'The evidence for the effectiveness of medical nutrition therapy in diabetes management', Diabetes Care 25(3), 608-613.         [ Links ]

Pastors, J.G., Franz, M.J., Warshaw, H., Daly, A. & Arnold, M.S., 2003, 'How effective is medical nutrition therapy in diabetes care?' Journal of the American Dietetic Association 103(7), 827-831.         [ Links ]

Peyrot, M., 1999, 'Behaviour change in diabetes education', Diabetes Educator 25(6) suppl., 62-73.         [ Links ]

Peyrot, M. & Rubin, R.R., 2007, 'Behavioural and psychosocial interventions in diabetes: A conceptual review', Diabetes Care 30(9), 2433-2439.         [ Links ]

Prochaska, J.O. & Velicer, W.F., 1997, 'The trans-theoretical model of health behaviour change', American Journal of Health Promotion 12, 38-48.         [ Links ]

Raidil, M., Spain, K., Lanting, R., Lockard, M., Hohson, S., Spencer, M., Sant, L., Welch, J., Liddil, A. & Hartman-Cunningham, M., 2007, 'The healthy diabetes plate', Preventing Chronic Disease; Public Health Research, Practice and Policy 4(1), 1-7.         [ Links ]

Ramachadran, A., Ramachadran, S., Snehalatha, C. & Murigesan, N., 2007, 'Increasing expenditure of health care incurred by diabetic subjects in developing countries: A study from India', Diabetes Care 30(2), 252-256.         [ Links ]

Rickheim, P.L., Weaver T.W., Flader, J.L., Kendall, D.M., 2002, 'Assessment of group versus individual diabetes education', Diabetes Care, 25, 271-274.         [ Links ]

Roper, N. A., Bilous, R.W., Kelly, W.F., Unwin, N.C. & Connoly, V.M., 2001, 'Excess mortality in a population with diabetes and the impact of material deprivation: Longitudinal, population base', British Medical Journal 322(7299), 1389-1393.         [ Links ]

Rosal, M.C., Olendzki, B., Reed, G.W., Gumieniak, O., Scavron, J. & Ockene, I., 2005, 'Diabetes self-management among low-income Spanish speaking patients: A pilot study', Annals of Behaviour Medicine 29(3), 225-235.         [ Links ]

Rosenstock, I.M., Strecher, V.J. & Becker, M.H., 1988, 'Social learning theory and the health belief model', Health Education Quarterly 15(2), 175-183.         [ Links ]

Ruggiero, L., 2000, 'Helping people with diabetes change behaviour: From theory to practice', Diabetes Spectrum 13(3), 125.         [ Links ]

Shabbidar, S., Fathi, B. & Shirazifard, N.M., 2006, 'Effects of clinical nutrition education on glycaemic control outcomes in type 2 diabetes', International Journal of Diabetes for Developing Countries 26(4), 156-159.         [ Links ]

Sherman, A.M., Bowen, D.J., Vitolins, M., Perri, M.G., Rosal, M.C., Sevick, M.A & Ockene, J.K., 2000, 'Dietary adherence: Characteristics and interventions', Controlled Clinical Trials 21, 206S-211S.         [ Links ]

Trento, M., Passera, P., Tomalino, M., Bajardi, M., Pomero, F., Allione, A., Vaccari, P., Molinatti, G.M & Porta, M., 2001, 'Group visits improve metabolic control in type 2 diabetes: A 2 year follow-up', Diabetes Care 24(6), 995-1000.         [ Links ]

Two-Feathers, J., Kieffer, E.C., Palmissano, G., Anderson, M., Sinco, B., Janz, N., Heisler, M., Spencer, M., Guzman, R., Thompson, J., Wisdom, K. & Sherman, A.J., 2005, 'Racial and ethnic approaches to community health (REACH) Detroit partnership: Improving diabetes related outcomes among African American and Latino adults', American Journal of PublicHealth 95(9), 1552-1560.         [ Links ]

Vallis, M., Ruggiero, L., Greene, G., Jones, L., Zinman, B., Rossi, S., Edwards, L., Rossi, J.S. & Proschaka, J.O., 2003, 'Stages of change for healthy eating in diabetes', Diabetes Care 26(50), 1468-1474.         [ Links ]

Van der Ven, N., 2003, 'Psychosocial group interventions in diabetes care', Diabetes Spectrum 16(2), 88-95.         [ Links ]

Wang, J., Armour, T., Geiss, L.S & Engelgau, M.M., 2005, 'Obesity and diabetes: Dual epidemics on the rise', Current Opinion in Endocrinology and Diabetes 12(2), 174-180.         [ Links ]

Warsi, A., Wang, P.S., LaValley, M.P., Avorn, J. & Solomon, D.H., 2004, 'Self management education programs in chronic disease: A systematic review and methodological critic of literature', Archives of Internal Medicine 16(15), 1641-1649.         [ Links ]

Wild, S., Roglic, G., Green, A., Sicree, R. & King, H., 2004, 'Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030', Diabetes Care 27(5), 1047-1053.         [ Links ]

Wilson, C., Brown, T., Acton, K. & Gilliland, S., 2003, 'Effects of clinical nutrition education and educator discipline on glycaemic control outcomes in Indian health service', Diabetes Care 26(9), 2500-2504.         [ Links ]

Wilson, S.R., 1997, 'Individual versus group education: Is one better?' Patient Education and Counseling 32, suppl., S67-S75.         [ Links ]

Ziemer, D.C., Berkowitz, K.J., Panayioto, R.M., El-Kebbi, I.M., Musey, V.C., Wanko, N.S., Slocum, W., Bacha, G.M., Musey, V.C., Gallina, D.L., Cook, C.B., Fowke, M.L., Anderson, L.A., Philips, L.S., Brazier, C.W. & Dunbar, V.G., 2003, 'A simple meal plan emphasizing healthy food choices is as effective as an exchange based meal plan for urban African American with type 2 diabetes', Diabetes Care 26(6), 1719-1724.         [ Links ]

 

 

Correspondence:
Jane W. Muchiri
Department of Human Nutrition
Faculty of Health Sciences
4-6 HW Snyman South Building
University of Pretoria
PO Box 667
Pretoria 0001
South Africa
E-mail: jane.muchiri@up.ac.za

Received: 14 July 2008
Accepted: 26 Nov. 2008
Published: 27 May 2009

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