A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes

Abstract

Background: Despite recommendations, many patients with type 2 diabetes receive dietary advice from nurses or doctors instead of individualized nutrition therapy (INT) that is provided by a dietitian. Objective: We performed a meta-analysis to compare the effect of INT that is provided by a registered dietitian with the effect of dietary advice that is provided by other healthcare professionals. Design: A systematic review was conducted of Cochrane library databases, EMBASE, CINAHL, and MEDLINE in the period 2004-2017 for guidelines, reviews, and randomized controlled trials (RCTs) that assessed the outcomes glycated hemoglobin (HbA1c), weight, body mass index (BMI; in kg/m 2 ), and LDL cholesterol. Risk of bias and the quality of evidence were assessed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: We identified 5 RCTs comprising 912 participants in total.In the first year of intervention (at 6 or 12 mo), nutrition therapy compared with dietary advice was followed by a 0.45% (95% CI: 0.36%, 0.53%) lower mean difference in HbA1c, a 0.55 (95% CI: 0.02, 1.1) lower BMI, a 2.1-kg (95% CI: 1.2-, 2.9-kg) lower weight, and a 0.17-mmol/L (95% CI: 0.11-, 0.23-mmol/L) lower LDL cholesterol. No longer-term data were available. Some of the included studies had a potential bias, and therefore, the quality of the evidence was low or moderate. In addition, it was necessary to pool primary and secondary outcomes. Conclusions: INT that is provided by a dietitian compared with dietary advice that is provided by other health professionals leads to a greater effect on HbA1c, weight, and LDL cholesterol. Because of the potential bias, we recommend considering nutrition therapy that is provided by a dietitian as part of lifestyle intervention in type 2 diabetes, but further randomized studies are warranted.Am J Clin Nutr 2017;106:1394-400.

Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes: changes in health cognitions and glycemic control

“…A more comprehensive dietary education program that addressed barriers such as lack of support from family and health services, time management and dietary myths [ 37 – 39 ] could result in an even better dietary behaviour change. A successful program could also take into consideration factors such as meal planning, diet quality, self-monitoring, dietary self-efficacy, social support and time management [ 40 – 43 ], and deliver it through trained professionals such as dieticians or nutritionists functioning as part of multidisciplinary teams [ 43 – 45 ].…”

People With Type 2 Diabetes Report Dietitians, Social Support, and Health Literacy Facilitate Their Dietary Change

“…It has previously been shown that better clinical parameters, such as reduced hemoglobin A1c concentration, weight loss, and improved lipid profile, are achieved when the dietary intervention is led by a dietitian as opposed to any other health professional. 10 Even a single session with a dietitian improves hemoglobin A1c levels. 11 Yet, suboptimal use of dietetic services is evident worldwide, with a large proportion of people with T2DM never consulting a dietitian.…”

Evaluación del nivel de participación del nutricionista en la prescripción dietética en hospitales públicos y privados de Chile

“…Están surgiendo pruebas de que la atención nutricional otorgada por el nutricionista se proporciona mejor y se logra un resultado superior del paciente (24)(25)(26).…”