Meal replacements: An educational tool for weight reduction in patients with diabetes in rural areas

Meal replacements: an educational tool for weight reduction in patients with diabetes in rural areas Richard J Santen, Emeritus Professor of Medicine at the University of Virginia, discusses how meal replacements can aid successful weight loss for individuals with diabetes living in rural, underserved communities. The incidence and prevalence of type 2 diabetes mellitus is increasing worldwide in parallel with that of obesity. Poorly controlled patients with diabetes mellitus can benefit from a consultation with an endocrinologist. However, patients living in rural, financially challenged, underserved areas in the US do not have access to endocrinologists to help manage their diabetes. This lack of specialists has resulted primarily from a marked workforce gap, particularly in underserved rural areas. A program developed by the author of this manuscript utilized telemedicine to evaluate and manage patients with diabetes attending rural, Federally Qualified Community Health Centers in the US. The rationale was to teach patients about diet, exercise, and medication management. The program has been successful in that hemoglobin A1c levels decreased from 10.3±1.94% to 7.78±1.5% in 139 patients completing the program. As evidence of the success of the self-management component, when patients were discharged from the program but followed for the next six to 18 months, the average hemoglobin A1c remained stable. However, the major failure of the study was that body weight did not change significantly. Recent guidelines strongly suggest that control of patients with type 2 diabetes requires a reduction in body weight and consider this equally important as glucose control.