Impact of Diabetes Prevention Guideline Adoption on Health Outcomes: A Pragmatic Implementation Trial

Published:December 03, 2020DOI:
      Limited research exists to evaluate nutrition guideline impact on clinical practice and patient health outcomes. In this study we investigate (1) the impact of guideline training on the implementation of the diabetes prevention Evidence-Based Nutrition Practice Guideline (EBNPG), and (2) the relationship between EBNPG congruence and resulting health outcomes in patients with prediabetes. We conducted an implementation study in which registered dietitian nutritionists (RDNs) provided nutrition care with 3-month follow-up to 102 pre-diabetes patients before and after a professional training on the implementation of the Diabetes Prevention EBNPG. Using the RDNs’ Nutrition Care Process (NCP) documentation, we measured percent guideline congruence and health outcomes (body weight, waist circumference, fasting glucose, glycosylated hemoglobin), and modeled health outcomes. Guideline congruence improved after training by 4.3% (P < 0.05). However, no significant associations were observed between guideline training, or guideline congruence and health outcomes. Our model showed a reduction in waist circumference (2.1 ± 0.92 cm; P = 0.023), and body weight (-1.78 ± 0.55 kg; P = 0.001) throughout the course of the study. Training of nutrition professionals improved congruence to EBNPG for Diabetes Prevention. Nevertheless, improved guideline congruence did not impact related health outcomes. Standard care including nutrition intervention resulted in body weight and waist circumference reductions. Future research needs to further address the impact of evidence-based guidelines on outcomes in all areas of practice.
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      W. J. Murphy is a data scientist, Academy of Nutrition and Dietetics, and a data scientist, Lumere Inc, a GHX Company, Chicago, IL.


      R. K. Hand is an assistant professor, Department of Nutrition, Case Western Reserve University, Cleveland, OH. At the time of the study she was director, Dietetics Practice Based Research Network, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.


      J. K. Abram is manager, Nutrition Research Network (former Dietetics Practice Based Research Network), Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.


      C Papoutsakis is senior director, Nutrition and Dietetics Data Science Center, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.