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Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review

Published:September 13, 2018DOI:https://doi.org/10.1016/j.jand.2018.06.303

      Abstract

      Background

      Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease.

      Objective

      Document outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association–recognized programs.

      Design

      Descriptive, retrospective chart review.

      Participants/setting

      Four random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained.

      Outcome measures

      Weight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio.

      Analysis

      Mixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters.

      Results

      Significant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001).

      Conclusions

      Reductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

      Keywords

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      Biography

      P. Z. Marincic is a professor and serves as associate vice president of health sciences, Idaho State University–Meridian, Meridian.

      Biography

      At the time of the study, M. V. Salazar is graduate student under Dr Marincic, Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL.

      Biography

      At the time of the study, C. Wyatt is graduate student under Dr Marincic, Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL.

      Biography

      A. Hardin is director, diabetes and clinical nutrition, East Alabama Medical Center, Opelika.

      Biography

      S. Scott is president & CVO, SCS Nutrition Consulting, LLC, Huntsville, AL; at the time of the study, she was also public policy coordinator, Alabama Dietetic Association, Montgomery.

      Biography

      S. X. Fan is a statistical consultant, Statistical Consulting Center, Department of Mathematics & Statistics, College of Science and Mathematics, Auburn, AL.

      Biography

      P. R. Gaillard is an associate professor, Department of Mathematics & Statistics, Statistical Consulting Center, Director, Auburn, AL.

      Biography

      L. Watson is a diabetes educator, Diabetes Control Center, Huntsville Hospital, Huntsville, AL.

      Biography

      P. Green is manager, Baptist Health Center for Diabetes and Nutrition Education, Baptist Health Hospital, Montgomery, AL.

      Biography

      P. Glover is diabetes control center program manager, Huntsville Hospital, Huntsville, AL.

      Biography

      M. Hand is a certified diabetes educator, Diabetes Treatment Center, Southeast Alabama Medical Center, Dothan.