Effectiveness of Medical Nutrition Therapy Provided by Dietitians in the Management of Non–Insulin-Dependent Diabetes Mellitus

Franz, Marion J.; Monk, Arlene; Barry, Bridgette A.; McCLAIN, Kathryn; Weaver, Tanya; Cooper, Nancy; Upham, Paul; Bergenstal, Richard M.; Mazze, Roger S.

doi:10.1016/s0002-8223(95)00276-6

Cited by 268 publications

(161 citation statements)

References 20 publications

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“…Only three studies involved didactic interventions (34,47,65), and only one of these studies showed a decrease in weight (47). A large number of studies examined the effects of self-management training on lipid levels, and some produced improvement in total cholesterol (range Ϫ0.9 to Ϫ0.07 mmol/dl) (66,68,81,83,93), LDL (Ϫ0.4 mmol/dl) (100), and HDL (ϩ0.1 mmol/dl) (100). Others found initial positive results but no significant difference from baseline at final follow-up (69,82,101).…”

Section: Continued On Following Pagementioning

confidence: 99%

Effectiveness of Self-Management Training in Type 2 Diabetes

2001

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OBJECTIVE -To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS -MEDLINE, EducationalResources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization.RESULTS -A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of selfmonitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (Ͻ6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined healthcare utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited.CONCLUSIONS -Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life. Diabetes Care 24:561-587, 2001D iabetes self-management training, the process of teaching individuals to manage their diabetes (1), has been considered an important part of clinical management since the 1930s (2). The goals of diabetes education are to optimize metabolic control, prevent acute and chronic complications, and optimize quality of life while keeping costs acceptable (3). One of the goals of Healthy People 2010 is to increase to 60% (from the 1998 baseline of 40%) the proportion of individuals with diabetes who receive formal diabetes education (4). There are significant knowledge and skill deficits in ...

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Section: Continued On Following Pagementioning

confidence: 99%

Effectiveness of Self-Management Training in Type 2 Diabetes

2001

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“…Even small weight losses are associated with a pronounced improvement of glucose tolerance [24,25]. Weight loss and improved glycaemia are also more readily achieved in subjects with diabetes of relatively short duration [26,27].…”

Section: Weight Loss Due To Calorie Loss In Glucosuriamentioning

confidence: 99%

Changes in patient weight and the impact of antidiabetic therapy during the first 5 years after diagnosis of diabetes mellitus

et al. 2006

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Aims/hypothesis It is generally thought difficult for type 2 diabetic patients to lose weight. We monitored changes in patients' weight during the first 5 years after diabetes diagnosis in relation to initiation of antidiabetic treatment. Subjects and methods Data from 711 newly diagnosed diabetic patients aged 40 or over were analysed with a random-effect linear-regression model. Patients were included consecutively from a well-defined patient list in general practice. Results In 245 patients whose only treatment was advice on diet, an initial weight loss of 6 to 7 kg was largely maintained over 5 years. Patients receiving metformin (n=86) or sulfonylureas (n=330) maintained an average weight loss of 2 to 4 kg that was dependent on age and sex. Patients' weight did not change on initiation of treatment with sulfonylureas or metformin. Over 5 years, median HbA 1c increased from 7.0 to 7.8% (reference range 5.4-7.4%) in the diet-alone group. HbA 1c was approximately 1 percentage point higher for most of the other treatment groups. Conclusions/interpretation In newly diagnosed type 2 diabetic patients, long-term weight loss was common and weight loss was not affected by sulfonylurea treatment. The measurements in the study are taken from treatment results achieved in the general population of diabetic patients, who are rarely treated in secondary care and seldom the subject of research; the results thus indicate that weight reduction is a practicable treatment in diabetic patients.

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“…This is important because lifestyle modification through nutrition and exercise can improve diabetes outcomes, [11][12][13] and there is some evidence that primary care-based counseling can enhance lifestyle modification. 14 Yet, studies have documented the underuse of lifestyle modification counseling in ambulatory care settings.…”

Section: Introductionmentioning

confidence: 99%