s; previous IGT; hypertension or hyperlipidemia; women with a history of GDM or delivery of infants over nine pounds (ADA, 1996; Javitt, Aiello, Chiang, Ferris, Canner, & Greenfield, 1994).
In 1992 it was estimated that percapita annual health care expenditures were more than three times greater for diabetics ($9,493) than nondiabetics ($2,604). Percapita expenses for confirmed diabetics ($11,157) were more than four times greater than for nondiabetics. Diabetics constituted 4.5 percent of the U.S. population in 1992 and accounted for 14.6 percent of the total U.S. health care expenditures ($85 billion); one in seven dollars was spent on diabetes (Rubin, Altman, & Mendelson, 1994).
Diabetes, a chronic illness, requires continuing medical care and education. Hyperglycemia is the hallmark of diabetes; treatment is aimed at lowering blood glucose levels. To achieve near normal blood glucose levels, self-management, patient education, and intensive treatment programs are necessary. Care involves self monitoring of blood glucose, meal planning, regular exercise, insulin regimens, instruction, continuing education, and periodic assessment of goals (ADA, 1996; Glasgow, 1995).
Nutritional recommendations of the ADA endorse individualization and set their guidelines accordingly. An important focus includes that of lengthening absorption time or spreading the nutrient load which results in lower mean blood glucose and insulin levels and reduced 24-h urinary C-peptide losses (Jenkins & Jenkins, 1995). ADA proposes that diet and exercise therapy alone are not enough to control hyperglycemia in NIDDM; the pharma
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