CommentaryHow effective is medical nutrition therapy in diabetes care?☆
Section snippets
Expected outcomes from MNT for patients with diabetes
Randomized controlled trials and observational studies of MNT have shown improved glycemic outcomes on the order of decreases in A1C of approximately 1 to 2 units (a 12% to 24% decrease in A1C). In patients with newly diagnosed type 2 diabetes, intensive nutrition therapy provided by registered dietitians decreased A1C levels by ~2 units (2, 3), whereas in patients with an average duration of type 2 diabetes of 4 years and in newly diagnosed patients with type 1 diabetes, intensive nutrition
When to evaluate the clinical data?
As providers of Medicare MNT for people with diabetes, registered dietitians must use nationally recognized protocols to provide MNT to be in compliance as providers (22, 23). The American Dietetic Association (ADA) MNT Evidence-Based Guides for Practice, Nutrition Practice Guidelines (NPGs) for type 1, type 2, and gestational diabetes meet this requirement. To achieve the results shown possible, dietetics professionals must understand expected outcomes from nutrition therapy and when to
How do we evaluate the clinical data?
The definition of an NPG adopted by the ADA is a protocol or clinical practice guideline that has been validated by clinical testing to evaluate whether the protocol works. Three NPGs have been validated by the diabetes community using randomized controlled trials that compared nutrition intervention with the NPGs to the usual care by a dietetics professional. Members of the ADA Diabetes Care and Education dietetic practice group (DPG) were instrumental in designing, implementing, and reporting
Summary
This commentary highlights that MNT provided by a registered dietitian experienced in diabetes management is clinically effective. However, completing just an initial primary nutrition intervention is not enough—follow-up is crucial. NPGs offer guidelines to help registered dietitians know what outcomes to evaluate to achieve positive results and at what intervals to schedule follow-up appointments (ie, 6 weeks to 3 months). The results of the nutrition intervention, regardless of whether the
Acknowledgements
The authors are members of a task force supported by the Diabetes Care and Education dietetic practice group of the American Dietetic Association.
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Address correspondence to: Joyce Green Pastors, MS, RD, PO Box 801417, Charlottesville, VA, 22908-0770. E-mail: [email protected].
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