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Margaret (Maggie) Powers, Ph.D., RD, CDE, is a Research Scientist at the International Diabetes Center at Park Nicollet Health Services. Her Ph.D. focused on performance improvement and the integration of clinical guidelines into health systems. Dr. Powers is pioneering work with continuous glucose monitoring to study the glycemic response of food. She is also leading the design of a validated instrument to assess risk of eating disorders in Type 1 diabetics.

How would you describe your work?

My main focus with diabetes is to make somewhat complicated research more understandable and useful to various audiences. We know that individual clinicians may want to do the right thing, but the health care system around them has to help facilitate that. Part of translating research is focusing on systems. We need to look at models of care.

Do you think we’re making progress?

I would say there is progress. Sometimes changing a system might be more challenging than changing individual providers but there is good news. Health care systems have evolved over 30 years and we need to first be clear about what we want and clearly examine what are the gaps in getting there. Sometimes there are very simple and inexpensive solutions. The exciting thing is that more and more health organizations are working hard to figure this out.

How does your experience as a registered dietician and educator help you contribute something unique to diabetes research?

I did my internship at Cook County Hospital in Chicago. At the time, many patients were having their limbs amputated due to poor diabetes control. Working with an endocrinologist, I saw the impact nutrition therapy could have on outcomes with people with diabetes. The endocrinologist made it very clear that nutrition was part of the care and I realized I could have an impact. It wasn’t just handing out diets. It was working with individuals within their life systems to modify eating habits that they could live with day in and day out. We were working with the poorest of the poor; people who were relying on food pantries, who often ran out of food at the end of the month. It was challenging from a medical standpoint and a socio-behavioral standpoint.

Currently, nutrition is playing a larger role in diabetes management than it used to. Why?

We once thought that to best manage Type 2 diabetes, one had to eliminate anything with sugars. Now we have research showing that you can have sugar, yet it’s about balancing it with other carbohydrate intake. Behaviorally, it’s important for some people to have a very structured food plan with limited choices. Others need gradual changes that start where they are. We try to find ways to maintain the essence of people’s likes, dislikes and cooking habits so people can make lifelong changes that balance with their metabolic needs. The most important thing is spreading carbs throughout the day and maintaining consistency. It’s really research that has led to this understanding.

Is this approach working?

It works when a person receives adequate education and follow up. If someone is just told to eat less and eat fewer carbs, it’s not going to work. Sixty-six percent of Americans are overweight or obese. If it was easy to change eating behaviors we wouldn’t have that problem. So we have to find the best way to help support the individual person between doctor’s visits. We know it works when patients receive support and resources they need. But it really needs to be a team effort. As a dietician, I’m not going to tell patients to totally avoid specific foods. My goal is to give them confidence and help them feel comfortable making healthy choices in a variety of situations.

Interview has been condensed and edited for space.

Tags: diabetes research • gluclose • health care costs • obesity • type 1 • type 2