Expanded role of the dietitian in the diabetes control and complications trial: Implications for clinical practice

Delahanty, Linda M.; Simkins, Sari W.; Camelon, Kathryn

doi:10.1016/0002-8223(93)91748-f

Cited by 89 publications

(43 citation statements)

References 11 publications

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“…These results, together with outcomes from other full scale trials (16–18) indicate that demanding lifestyle interventions involving significant modification of dietary intake can be successfully implemented over extended periods of time (16–19). In an interim efficacy report from the WINS trial, breast cancer recurrence was less frequent in women randomized to the intervention group and subgroup analyses suggested a larger effect on hormone receptor negative breast cancers (3).…”

Section: Discussionmentioning

confidence: 64%

Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

Hoy¹,

Winters²,

Chlebowski³

et al. 2009

Journal of the American Dietetic Association

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The Women’s Intervention Nutrition Study is a randomized clinical trial designed to evaluate if a lifestyle intervention targeting fat intake reduction influences breast cancer recurrence in women with early stage, resected disease receiving conventional cancer management. This report details the concept, content, and implementation of the low-fat eating plan used in the dietary intervention group of this trial. Intervention group participants were given a daily fat gram goal. The intervention was delivered by centrally trained, registered dietitians who applied behavioral, cognitive, and motivational counseling techniques. The low-fat eating plan was implemented in an intensive phase with eight biweekly (up to Month 4), individual counseling sessions followed by a maintenance phase (Month 5 up to and including Year 5) with registered dietitian visits every 3 months and optional monthly group sessions. Self-monitoring (daily fat gram counting and recording), goal setting, and motivational interviewing strategies were key components. Dietary fat intake was equivalent at baseline and consistently lower in the intervention compared with the control group at all time points (percent eneregy from fat at 60 months 23.2% ± 8.4% vs 31.2% ± 8.9%, respectively, P< 0.0001) and was associated with mean 6.1 lb mean weight difference between groups (P = 0.005) at 5 years (baseline and 5 years, respectively: control 160.0 ± 35.0 and 161.7 ± 32.8 lb; intervention 160.2 ± 35.1 and 155.6 ± 32.1 lb). Together with previously reported efficacy results, this information suggests that a lifestyle intervention that reduces dietary fat intake and is associated with modest weight loss may favorably influence breast cancer recurrence. The Women’s Intervention Nutrition Study low-fat eating plan can serve as a model for implementing such a long-term dietary intervention in clinical practice.

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Section: Discussionmentioning

confidence: 64%

Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

Hoy¹,

Winters²,

Chlebowski³

et al. 2009

Journal of the American Dietetic Association

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“…Nurses have been utilized most often as instructors in the delivery of formal DSME (2,3,5,63–67). With the emergence of medical nutrition therapy (66–70), registered dietitians became an integral part of the diabetes education team. In more recent years, the role of the diabetes educator has expanded to other disciplines, particularly pharmacists (73–79).…”

Section: Standardsmentioning

confidence: 99%

National Standards for Diabetes Self-Management Education

Funnell

Brown

Childs³

et al. 2010

Diabetes Care

335

324

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Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community.A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/ behaviorists, registered nurses, and registered dietitians; and a pharmacist.The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. DEFINITION ANDOBJECTIVES -Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.GUIDING PRINCIPLES -Before the review of the individual Standards, the Task Force identified overriding principles based on existing evidence that would be used to guide the review and revision of the DSME Standards. These are:1. Diabetes education is effective for improving clinical outcomes and quality of life, at least in the short-term (1-7). 2. DSME has evolved from primarily didactic presentations to more theoretically based empowerment models (3,8). 3. There is no one "best" education program or approach; however, programs incorporating behavioral and psychosocial strategies demonstrate improved outcomes (9 -11). Additional studies show that culturally and ageappropriate programs improve outcomes (12-16) and that group education is effective (4,6,7,17,18). 4. Ongoing support is critical to sustain progress made by participants during the DSME program (3,13,19,20). 5. Behavioral goal-setting is an effective strategy to support self-management behaviors (21). STANDARDSStructure Standard 1. The DSME entity will have documentation of its organizational structure, mission statement, and goals and will recognize and support quality DSME ...

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“…The importance of dietary management have been strongly underscored by the diabetes control and complications trial (DCCT) and UK prospective diabetes study (UKPDS). [8–10] Although, during Ramadan, the benefits of fasting appear only in patients who maintain their appropriate diets. [1112] most patients with diabetes find it increasingly difficult to understand and adhere to the nutritional component of their treatment.…”

Section: Introductionmentioning

confidence: 99%

A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan

Vasan

Karol

Mahendri

et al. 2012

Indian J Endocr Metab

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Aims:The aim was to assess the dietary pattern during Ramadan season among type 2 diabetic Muslim subjects who underwent fasting and intensive dietary counseling.Materials and Methods:The study was conducted among 70 Muslim subjects with type 2 diabetes mellitus who undertook fasting during Ramadan and was part of a randomized control trial using pioglitazone published previously. All subjects were subjected to a dietary assessment and counseling at three stages, i.e., initiation of the study, mid-Ramadan and post-Ramadan, by a trained dietician. Dietary assessment was done by the 24-hour dietary recall method and the food frequency questionnaire. Diabetic diet sheets were dispensed to subjects based on their body mass index (BMI), daily activity, and needs.Results:The mean caloric intake between pre-Ramadan (before fasting) and mid-Ramadan (15 days after fasting) were 1506.80 kcal and 1614.29 (P = 0.001) respectively. The distribution of active components pre and during Ramadan were: carbohydrates (g) 260.76 and 265.35 g (P = 0.001), proteins (g) 43.64 and 46.19 (P = 0.001) and fat (g) was 32.88 and 44.16 (P = 0.0001) respectively. The percentage of energy from dietary carbohydrate prior to fasting (64.11 ± 6.73) and during fasting (68.41 ± 4.41) remained almost unchanged but statistically significant when compared at different intervals before and during fasting. Fat intake increased significantly during fasting (P = < 0.001).Conclusions:The dietary composition in a type 2 diabetic Muslim population who undertook fasting during Ramadan showed a mean increase in consumption of all components of diet during the period of fasting. Nutritional compliance during such a time seems to be difficult and warrants repeated counseling and regular follow-up to achieve targets.

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Expanded role of the dietitian in the diabetes control and complications trial: Implications for clinical practice

Cited by 89 publications

References 11 publications

Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

National Standards for Diabetes Self-Management Education

A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan

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