Nutritional Literacy Among Uninsured Patients With Diabetes Mellitus: A Free Clinic Study

Objective

Evaluate nutrition literacy in uninsured subjects with diabetes mellitus (DM) who presented to free diabetes management classes. 

Design 

This single-site, cross-sectional observational study recruited thirty subjects from a free clinic for uninsured patients to attend diabetes mellitus, self-management classes. Before starting the classes, DM care-related data were collected, and subjects were administered the Nutrition Literacy Assessment Instrument (NLit). The assessment covers six subscales in nutrition and categorizes results into three possible categories: the likelihood of poor nutrition literacy (NLit Score ≤ 44), the possibility of poor nutrition literacy (NLit Score- 45-57), and the likelihood of good nutrition literacy (NLit score ≥ 58). 

Results 

Median glycated haemoglobin (HbA1c) was 7.45% for study participants. The mean NLit score was 38.1 (SD ± 9.4), correlating with a likelihood of poor nutrition literacy. All participants had either likelihood or the possibility of poor nutrition literacy based on the NLit Assessment. There were no participants who scored in the range of likelihood of good nutrition literacy. Subjects who scored in the range of likelihood of poor nutrition literacy had a significantly higher mean HbA1c (8.6 %) than those who scored in the possibility of poor nutrition literacy (6.9 %, p=0.005).

Conclusions

Poor nutrition literacy is associated with worse glycemic control among uninsured subjects with diabetes mellitus.

SUN-056 Recurrent Pancreatitis Induced by Uncontrolled Type V Hyperlipoproteinemia

Background:&nbsp;Type V Hyperlipoproteinemia is a rare disease characterized by increased chylomicron and very low-density lipoprotein (VLDL) plasma levels. No official guidelines for treatment or monitoring of this disorder have been established due to the scarcity of cases. We present a patient with recurrent episodes of pancreatitis and diffuse eruptive xanthomas associated with uncontrolled type V hyperlipoproteinemia requiring recurrent Intensive Care Unit (ICU) admissions for management of his condition. Clinical Case:&nbsp;A 28 y/o male with Type V Hyperlipoproteinemia, Hypertension, uncontrolled Type 2 Diabetes Mellitus (DM2) and history of non-compliance, presented with epigastric pain and increased xanthoma formation. Family history was remarkable for hypertriglyceridemia and Coronary Artery Disease in his father and grandfather. On examination, he had moderate epigastric tenderness along with diffuse and extensive xanthomas in both hands, knees, and thighs. Outpatient regimen for the management of the hyperlipoproteinemia consisted of Gemfibrozil 600mg twice daily, Niacin 2000mg daily, and Omega-3 2,000mg twice daily. He was also on Lantus and Novolog for the management of DM2,&nbsp;last&nbsp;A1C being 12.4 %. Laboratories for this admission showed triglycerides >5,680 mg/dl (n<150 mg/dl) , Cholesterol >2,820 mg/dl , HDL 30 mg/dl , LDL 29 mg/dl, Lipase 17 u/L (n <78 u/L) , Amylase 54 u/L ( n <125 u/L) . MRCP showed an atrophic pancreas. The patient was admitted to the ICU for the management of recurrent pancreatitis secondary to severe hypertriglyceridemia. He was started on&nbsp;intravenous&nbsp;insulin drip, restarted on home medications, low-fat diet, and Pravastatin. After 8 days on the insulin&nbsp;drip&nbsp;his triglycerides had decreased to 566 mg/dl and abdominal pain had resolved. He subsequently underwent a celiac plexus nerve block due to recurrent admissions for abdominal pain. Conclusion:&nbsp;Type V Hyperlipoproteinemia is a complex lipid disorder that is likely due to triglyceride overproduction and clearance defect of VLDL. Environmental factors such as uncontrolled DM2, obesity, and increased alcohol intake can worsen the disease and lead to hypertriglyceridemia associated pancreatitis. Treatment involves lifestyle modifications, and medications, such as fibrates, nicotinic acid, fish oil if indicated to prevent pancreatitis and to lower cardiovascular risk. We present a case of hereditary hyperlipoproteinemia causing significant morbidity and recurrent ICU admissions for the treatment of severe hypertriglyceridemia. Due to the severity of hypertriglyceridemia and acute pancreatitis, intravenous insulin was used to enhance lipoprotein lipase activity to accelerate chylomicron and VLDL metabolism, therefore decreasing triglycerides. Although rare, this genetic disorder can cause significant and recurrent pancreatitis that may increase mortality if not appropriately treated.

QIM19-140: A New Standard of Care

Background: Nationally, many cancer survivors do not receive a survivorship care plan following completion of therapy. The American College of Surgeons’ Commission of Cancer’s Standard 3.3 requirement for accreditation placed this issue front and center for many of the participating cancer programs. The Commission on Cancer (CoC) survey found only one fifth of the cancer programs would be successful by 2015 and thus updated the standard in 2017. We describe a successful process created to deliver on this standard in an NCI designated cancer center to meet the needs of our patients. Methods: In early 2017, a multidisciplinary task force was created to initiate and implement survivorship care plans for newly diagnosed patients. Eligibility for care plans is determined by the CoC and the Moffitt cancer committee. The initiative included a cost-effective solution, “Journey Forward.” Moffitt Cancer Center was able to incorporate additional specific patient education and surveillance recommendations. A dedicated nursing team creating the care plans individually discussed with patients with the oversight of the Cancer Committee. Results: With collaboration from the cancer registry, nursing leadership and survivorship clinic, the diseases targeted initially were breast, gastrointestinal, genitourinary, head and neck, gynecology, non-small cell lung, thyroid, and lymphoma. Within 5 months of inception of the task force, 25% of survivorship care plans (SCP) were completed and by the end of the 2017 calendar year, we delivered 50% of analytic cases treated, amounting to approximately 2,500. The care plans were housed in the electronic medical record and available for patients via the patient portal. Conclusions: This initiative is made up of a multidisciplinary team from senior leadership, cancer committee members, the cancer registry, the survivorship clinic staff, nursing, social work, health information management, case management, and our information technology colleagues. A shared passion and vision lead the task force’s momentum. We all believed this was not just a mandate to comply with but a communication tool that is essential for our patients’ wellness long-term. Although there is minimal evidence to show the benefit of SCP with regard to outcomes, our team felt this document can indeed assist cancer patients’ transition into the next phase of their journey. Our project has improved the patient experience with positive feedback.

QIM19-141: SOAR (Survivors Overcoming and Achieving Resilience)

Background: There are 4 components of survivorship care: prevention, surveillance, interventions, and coordination between oncology and primary care/specialists. As part of the initial visit in Moffitt’s survivorship program, we provide a comprehensive and personalized care plan to our patients with a focus on wellness. We understand the transition from active treatment into the extended phase of survivorship can be fraught with many unexpected physical, emotional, psychological, and social challenges, yet this could also be a critical period where survivors are uniquely positioned to adopt healthy and resilient behaviors. We want to help patients be empowered through knowledge from interactive and multidisciplinary classes and we aim at improving their quality of life. Methods: We created an 8-week curriculum customized and designed for breast cancer survivors by experts in nutrition, social work, physical therapy, yoga, arts in medicine, and survivorship medicine with utilization technique–driven live food demonstrations. The core message of the series is further echoed and instilled by use of weekly journaling and guidance on how to practice the techniques following each class. Results: We completed one 8-week course. 15 patients were enrolled in the program; of these 9–12 participants consistently presented to the sessions. Sessions consisted in education regarding nutrition, emotional health, exercise, mindfulness, and medical management after completing cancer treatment. To further determine the impact of sessions, we are measuring change in health-related quality of life through the RAND-36 questionnaire with a precourse survey and a postcourse survey. As we continue our sessions and our patient population increases, we expect to have substantial data to report on the impact of this curriculum. Conclusions: It is estimated that there are more than 3.1 million women in the United States with history of breast cancer. Development of a multidisciplinary program focused in comprehensive care for breast cancer survivors may improve quality of life. These techniques can positively impact the transition from active treatment and position survivors to be better managers of their wellness.