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The Effect of Medical Nutrition Therapy by a Registered Dietitian Nutritionist in Patients with Prediabetes Participating in a Randomized Controlled Clinical Research Trial

Published:September 11, 2014DOI:https://doi.org/10.1016/j.jand.2014.07.020

      Abstract

      Background

      Prior studies have provided evidence that lifestyle change prevents or delays the occurrence of type 2 diabetes mellitus. The challenge is to translate research evidence for type 2 diabetes mellitus prevention into health care settings.

      Objective

      We investigated the effect of medical nutrition therapy (MNT) compared with usual care on fasting plasma glucose values, glycated hemoglobin (HbA1c), serum lipid levels, and Diabetes Risk Score, from baseline to the end of a 12-week intervention in overweight or obese adults with prediabetes.

      Design

      Prospective, randomized, parallel group study of 76 adults with impaired fasting plasma glucose or an HbA1c of 5.7% to 6.4%, recruited between April 2010 and May 2011 who completed a 12-week intervention period.

      Main outcome measures

      The primary outcome measure was fasting plasma glucose. Secondary outcome measures were HbA1c, serum lipid levels, and Diabetes Risk Score.

      Statistical analyses

      A factorial repeated measures analysis of variance was used to make comparisons between the two groups (the MNT and usual care groups) and two measures of time (baseline and 12 weeks postintervention). Data analysis was performed using the Statistical Package for the Social Sciences (release 19.0, 2010, SPSS Inc).

      Results

      There was a significant interaction for group assignment and HbA1c (P=0.01), with the MNT group experiencing significantly lower HbA1c levels than the usual care group (5.79% vs 6.01%) after the 12-week intervention. There was a significant interaction for group assignment and Diabetes Risk Score (P=0.001). Diabetes Risk Score for the MNT group decreased from 17.54±3.69 to 15.31±3.79 compared with the usual care group score, which went from 17.23±4.69 to 16.83±4.73. Regardless of group assignment, both groups experienced a reduction in total cholesterol (P=0.01) and low-density lipoprotein cholesterol (P=0.04) level.

      Conclusions

      The results demonstrate that individualized MNT is effective in decreasing HbA1c level in patients diagnosed with prediabetes.

      Keywords

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      References

      1. National diabetes fact sheet 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed January 15, 2012.

      2. Direct and indirect costs of diabetes in the United States. http://www.diabetes.org/diabetes-basics/diabetes-statistics/. Accessed January 15, 2012.

        • American Diabetes Association
        Economic costs of diabetes in the U.S. in 2007.
        Diabetes Care. 2008; 31: 596-615
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2009; 32: S62-S67
        • American Diabetes Association
        Standards of Medical Care in Diabetes-2012.
        Diabetes Care. 2012; 35: S11-S63
        • Zhang X.
        • Gregg E.W.
        • Williamson D.F.
        A1C level and future risk of diabetes: A systematic review.
        Diabetes Care. 2010; 33: 1665-1673
        • Diabetes Prevention Program Research Group
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001; 344: 1343-1350
        • Pan X.R.
        • Li G.W.
        • Hu Y.H.
        • et al.
        Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study.
        Diabetes Care. 1997; 20: 537-544
      3. Anaheim, California State and County quickfacts. http://quickfacts.census.gov/qfd/states/06/0602000.html. Accessed January 15, 2012.

        • Gottschlich M.
        • Fuhrman P.
        • Hammond K.
        • et al.
        The Science and Practice of Nutrition Support.
        Kendall/Hunt Publishing, Dubuque, IA2001
        • American Diabetes Association
        Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications.
        Diabetes Care. 2002; 25: S50-S60
        • American Diabetes Association
        Nutrition recommendations and interventions for diabetes.
        Diabetes Care. 2008; 31: S61-S78
      4. Academy of Nutrition and Dietetics Evidence Analysis Library. http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key=621. Accessed January 15, 2012.

        • American Diabetes Association
        Standards of medical care in diabetes-2010.
        Diabetes Care. 2010; 33: S11-S61
        • Thompson D.
        Improving V02max.
        ACSM Health Fitness J. 2005; 9: 94
        • Lindstrom J.
        • Tuomilehto J.
        The Diabetes Risk Score.
        Diabetes Care. 2003; 26: 725-731
        • Heikes K.E.
        • Eddy D.M.
        • Arondekar B.
        • Schlessinger L.
        Diabetes Risk Calculator.
        Diabetes Care. 2008; 31: 1040-1045
        • Whittemore R.
        • Melkus G.
        • Wagner J.
        • et al.
        Translating the diabetes prevention program to primary care.
        Nursing Res. 2009; 58: 2-12
        • Kulzer B.
        • Hermanns N.
        • Gorges D.
        • et al.
        Prevention of diabetes self-management program (PREDIAS): Effects on weight, metabolic risk factors, and behavioral outcomes.
        Diabetes Care. 2009; 32: 1143-1146
        • Asbetz P.
        • Valve R.
        • Oldenburg B.
        Type 2 diabetes prevention in the real world.
        Diabetes Care. 2007; 30: 2465-2470
        • Ramachandran A.
        • Snehalatha C.
        • Mary S.
        • et al.
        The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
        Diabetologia. 2006; 49: 289-297
      5. The A1C test. http://forecast.diabetes.org/diabetes-101/a1c-test. Accessed January 15, 2012.

        • Selvin E.
        • Marinopoulos S.
        • Berkenblit G.
        • et al.
        Meta-analysis: Glycosylated hemoglobin and cardiovascular disease in diabetes mellitus.
        Ann Intern Med. 2004; 141: 421-431
        • Hebert J.R.
        • Ebbeling C.B.
        • Ockene I.S.
        • et al.
        A dietitian-delivered group nutrition program leads to reductions in dietary fat, serum cholesterol, and body weight: The Worcester Area Trial for counseling in hyperlipidemia.
        J Acad Nutr Diet. 1999; 99: 544-552
        • McCoin M.
        • Sikand G.
        • Johnson E.Q.
        • et al.
        The effectiveness of Medical Nutrition Therapy delivered by registered dietitians for disorders of lipid metabolism: A call for further research.
        J Acad Nutr Diet. 2008; 108: 233-239
        • American Diabetes Association
        Standards of medical care in diabetes-2011.
        Diabetes Care. 2011; 34: S11-S61
        • Hamman R.F.
        • Wing R.R.
        • Edelstein S.L.
        • et al.
        Effect of weight loss with lifestyle intervention on risk of diabetes.
        Diabetes Care. 2006; 29: 2102-2107
        • Tibaldi J.
        Importance of postprandial glucose levels as a target for glycemic control in type 2 diabetes.
        South Med Assoc. 2009; 102: 60-66
        • American Diabetes Association
        Standards of medical care in diabetes-2009.
        Diabetes Care. 2009; 32: S13-S61

      Biography

      A. R. Parker is a research dietitian and a certified diabetes educator, Anaheim Clinical Trials, Anaheim, CA.

      Biography

      P. J. Winkle is a physician, Anaheim Clinical Trials, Anaheim, CA.

      Biography

      L. Byham-Gray is an associate professor, Department of Nutritional Sciences, and director, Masters in Clinical Nutrition Program, School of Health-Related Professions, Rutgers University, formerly known as the University of Medicine and Dentistry of New Jersey, Stratford.

      Biography

      R. Denmark is an associate professor, Interdisciplinary Studies, Rutgers University, formerly known as the University of Medicine and Dentistry of New Jersey, Stratford.