Outcomes Monitoring and Implementing Evidence-Based Nutrition Practice Guidelines for Type 2 Diabetes Mellitus in 2 Middle Eastern Countries

Abstract

Use of the Academy of Nutrition and Dietetics (Academy) evidence-based nutrition practice guidelines has not been tested internationally. The International Diabetes Outcomes Study explored implementation of the Academy evidence-based nutrition practice guidelines in Turkey and Israel by registered dietitians. The mean hemoglobin A 1c levels decreased from 7.6% to 9.1% at baseline to 6.2% to 7.4% for participants in Turkey and Israel, respectively. Patients at goal increased from baseline to 12 months for low-density lipoprotein cholesterol and triglyceride. Most subjective ratings for lifestyle behavior changes improved and were positively correlated with hemoglobin A 1c change. Outcomes suggest that Academy evidence-based nutrition practice guidelines could be adopted internationally with resources for training, translation, and adaptations.

Implementing Evidence-Based Nutrition Practice Guidelines for Type 2 Diabetes Mellitus in Lebanon

“… 4 , 7 Nutrition intervention is a cornerstone of diabetes management to achieve and maintain optimal glycemic and metabolic control and to improve overall health. 6 , 20 Although implementation of the Academy EBNPGs for T2DM has been evaluated in the United States and other countries, 17 , 18 it was unclear whether using the same EBNPGs would yield similar outcomes because of variation in the sample population and the Lebanese health care system compared with the United States. Thus, the aim of the present study was to explore the outcome of implementing the Academy EBNPGs for diabetes in a sample of Lebanese patients newly diagnosed with T2DM.…”

“…Previous studies have also documented similar improvements in patients' glycemic control and metabolic outcomes following a nutrition intervention. 17 – 20 A study conducted by Franz et al 19 among 179 American patients with type 2 diabetes reported a reduction in HbA 1C at 6 months compared with the baseline value (among 94 patients who had received a nutrition intervention), and results were used in the creation of the first 2001 Academy of Nutrition and Dietetics Guidelines for T2DM. Likewise, a study by Laitinen et al 21 indicated that compliance with dietary recommendations, following 12 months of intensified nutrition education, led to a reduction in serum lipids in obese patients newly diagnosed with T2DM.…”

“…Although the improvements seen in our patients' glycemic control and metabolic outcomes may not be attributed solely to the implementation of the Academy EBNPGs, it is appropriate to conclude that patients achieved similar results when the EBNPGs were implemented in Lebanon, compared with the United States and a EBNPGs project in Turkey. 17 , 18 In the United States, Lemon et al, 18 who conducted a study among 221 patients newly diagnosed with T2DM using the Academy 2001 Nutrition Guidelines for T2DM, reported a reduction in HbA 1C at 6 months postintervention. In a study conducted among 68 Turkish patients newly diagnosed with T2DM, improvement in patients' glycemic control and metabolic outcomes following implementation of the Academy EBNPGs was also documented.…”

“…In a study conducted among 68 Turkish patients newly diagnosed with T2DM, improvement in patients' glycemic control and metabolic outcomes following implementation of the Academy EBNPGs was also documented. 17 …”

“…In the United States and other countries, the use of the Academy Evidence-Based Nutrition Practice Guidelines (EBNPGs) for T2DM as part of medical care resulted in significant improvement in glycemic control and lifestyle clinical indicators in patients with type 2 diabetes. 17 – 19 However, it is unclear whether these guidelines, developed by and for dietitians practicing in the United States, will yield similar results when used in Lebanon. It has a different health care system, culture, and patient population.…”