Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

Meloncelli, Nina; Wilkinson, Shelley A.; Jersey, Susan de

doi:10.1055/s-0040-1722316

Cited by 5 publications

(6 citation statements)

References 88 publications

(149 reference statements)

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“…8 Dietitians have the challenge of providing individualised care in the context of navigating the limitations in dietetic staffing and in the current evidence to guide practice in this clinical area. 25 However, although, individualisation of MNT may explain the variations in MNT found in these surveys, it is not possible to determine this because of the survey design. Dietitians were asked to state what MNT they usually advise and not how advice differs between individuals.…”

Section: Discussionmentioning

confidence: 97%

“…The wide range in percentage energy from carbohydrate recommended in the updated NPG also allows scope for evidence‐based variations in practice 8 . Dietitians have the challenge of providing individualised care in the context of navigating the limitations in dietetic staffing and in the current evidence to guide practice in this clinical area 25 …”

Section: Discussionmentioning

confidence: 99%

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Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

Barnes

Morrison

Flack

et al. 2022

J Human Nutrition Diet

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Background The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence‐Based Nutrition Practice Guidelines (NPG). Methods Cross‐sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. Results In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%–25% energy from protein and 15%–30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%–65% in 2019 vs. 20%–75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40–220 and 60–300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). Conclusions Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

Barnes

Morrison

Flack

et al. 2022

J Human Nutrition Diet

View full text Add to dashboard Cite

show abstract

“…Caloric restriction is generally advised only for overweight and obese pregnant women with GDM [ 65 , 66 ]. However, there is no consensus on specific diet characteristics including carbohydrate distribution and quantity due to the limited number of high quality clinical trials and the complexity that such interventions and studies will warrant [ 65 , 66 , 70 , 76 ].…”

Section: Discussionmentioning

confidence: 99%

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

et al. 2022

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Background Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. Objectives To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. Search strategy Twelve bibliographic databases and reference list of related studies from inception until January 2022. Selection criteria All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). Data collection and analysis Data were extracted using modified Cochrane’s data extraction template. Studies were evaluated using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). Main results Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention. Conclusions Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes. Funding There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.

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“…Caloric restriction is generally advised only for overweight and obese pregnant women with GDM 59,60 . However, there is no consensus on speci c diet characteristics including carbohydrate distribution and quantity due to the limited number of high quality clinical trials and the complexity that such interventions and studies will warrant 59,60,64,70 .…”

Section: Discussionmentioning

confidence: 99%

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

Igwesi-Chidobe

Okechi

Emmanuel

et al. 2022

Preprint

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BackgroundNon-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. ObjectivesTo systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. Search StrategyTwelve bibliographic databases and reference list of related studies from inception until January 2022. Selection CriteriaAll primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). Data Collection and AnalysisData were extracted using modified Cochrane’s data extraction template. Studies were evaluated using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634).Main Results27 studies involving 6,242 pregnant women with GDM involved self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Limited/conflicting evidence was found for other outcomes and interventions. ConclusionsCommunity-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.

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Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

Cited by 5 publications

References 88 publications

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

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