The "Things We Do for No Reason TM (TWDFNR)" series reviews practices, which have become common parts of hospital care, may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
Carbohydrate (carb) ingestion strongly influences postprandial glucose (PPG). With recent interest in the role PPG plays in A1c and diabetic complications, there are research and clinical needs to quantify routine carb consumption. The 24-hour dietary recall is the gold standard for estimating carbs eaten, but it is tedious and narrowly focused. We developed a simple self-report to measure carbs routinely consumed (CRC). We hypothesized that the CRC would: 1) be reliable, 2) correlate with the 24-hour dietary recall, 3) be sensitive to a PPG-lowering intervention, and 4) reflect changes in A1c. Adults with type 2 diabetes (n = 116; mean age: 56 ± 11.6 years; mean disease duration: 5.3 ± 3 years; mean A1c: 8.2 ± 1.0) participated in a clinical trial comparing weight reduction to PPG reduction. At baseline and 3-month follow-up, participants completed the CRC, 3 days of ASA24 dietary recall, and A1c. The CRC score was the sum of the number of servings of 16 different high-carb food classes eaten (e.g., dried fruits) in an average week. The CRC mean was 35.9 ± 16.1. One-week test-retest reliability (r) was .96 (p = .02). Validity: At baseline, carbs eaten by CRC and ASA24 dietary recall were correlated (r = .43, p < .001). Change in CRC from baseline to follow-up was significantly lower for the PPG group (36.8 to 20.3, p <.001) but not for the weight-lowering group (33.0 to 34.4, p = .7). Correlation of pre-post change in A1c with CRC and ASA24 were r = .39 (p = .002) and r = -.03 (p = .8) respectively. Regression analysis indicated only the change in CRC predicted change in A1c. These data indicate the CRC is reliable and shows concurrent, discriminant and predictive validity - only changes in CRC reflected changes in A1c. The CRC may be useful to researchers in evaluating programs designed to lower carb intake. Clinicians might use it to evaluate a patient’s routine consumption of carbs and responsiveness to lifestyle interventions. Limitation: the CRC is not a comprehensive nutritional analysis. Disclosure D. Cox: None. M.A. Moncrief: None. T. Banton: None. V.M. Ngo: None. H. Singh: None. A.M. Diamond: None. A.L. McCall: None. Funding National Institutes of Health (R01DK108957); Dexcom, Inc. (IIS-2016-047)
The national struggles for social justice that have dominated headlines since 2020 are reflected in the challenges academic health centers are confronting as they strive to become more antiracist. One of the largest challenges for these institutions may be the inertia of the status quo. While faculty may have become accustomed to a status quo that perpetuates inequity, students provide perspectives that can disrupt this inertia and lead to positive change. Students, however, face barriers to antiracist work, including power gradients (i.e., different amounts of power people possess according to their position in a hierarchy) and a need to be accepted as part of the physician profession. In this article, the authors examine these challenges to student antiracist advocacy. They identify student empowerment, faculty allyship, and sustainability as essential principles for student antiracist work. They suggest this work could be operationalized through sequential student-led task forces focused on addressing the most pressing antiracist issues. The authors further recommend an approach to professionalism and development of a physician professional identity based on the values of antiracism rather than on existing norms. With this foundation, students may be able to engage in antiracist work, build professional identities that are more antiracist, and become physicians who can ensure a more just health care environment for their patients and communities.
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