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Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review
Journal of the Academy of Nutrition and Dietetics ( IF 3.5 ) Pub Date : 2019-03-01 , DOI: 10.1016/j.jand.2018.06.303
Patricia Z. Marincic , Maria V. Salazar , Amie Hardin , Susan Scott , Shirley X. Fan , Philippe R. Gaillard , Christopher Wyatt , Laura Watson , Pamela Green , Pam Glover , Molly Hand

BACKGROUND Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease. OBJECTIVE Document outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association-recognized programs. DESIGN Descriptive, retrospective chart review. PARTICIPANTS/SETTING Four random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained. OUTCOME MEASURES Weight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio. ANALYSIS Mixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters. RESULTS Significant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001). CONCLUSIONS Reductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

中文翻译:

糖尿病自我管理教育和医学营养治疗:一项多地点研究,通过回顾性图表审查记录注册营养师在血糖控制和糖尿病血脂异常管理方面的干预效果

背景 糖尿病自我管理教育 (DSME) 和医学营养治疗 (MNT) 可改善血糖控制并降低慢性合并症的风险。目的 记录通过美国糖尿病协会认可的计划完成 DSME 和 MNT 的 2 型糖尿病 (T2D) 患者的结果。设计 描述性、回顾性图表审查。参与者/设置 2013 年 6 月至 2014 年在阿拉巴马州的四个区域中心完成 DSME 和 MNT 的 T2D 患者的 100 个记录的四个随机样本被选择进行审查;排除后,保留了 392 条记录。结果测量 体重、体重指数 (BMI)、血红蛋白 A1c (HbA1c)、总胆固醇、低密度脂蛋白、高密度脂蛋白 (HDL)、甘油三酯 (TG) 和 TG 与 HDL 的比率。分析 使用混合模型方差分析来确定连续变量之间的差异。McNemar 检验用于评估患者达到血糖目标的频率。配对 t 检验用于确定脂质参数的显着性。结果 在计划结束和 1 年时观察到体重显着降低(2.67±5.54 kg,P<0.001;2.25±5.45 kg,P=0.001)、BMI(0.93±1.91,P<0.001;0.76±1.93,P= 0.001)和 HbA1c(1.82%±2.23%,P<0.001;1.22%±2.15%,P<0.001)。仅通过饮食管理的患者的平均基线 HbA1c 为 6.95%,并且在计划结束时 HbA1c 降低 0.8%(P<0.001)。那些接受饮食加药物治疗的患者的基线 HbA1c 为 9%,HbA1c 降低了 2.09%(P<0.001)。在 DSME 和 MNT 之后,62% 的患者达到了血糖目标(HcA1c≤7%),与基线时的 32% 相比(P<0.001)。从基线 (162±74 mg/dL [4.19±1.91 mmol/L]) 到随访 (109±36 mg/dL [2.82±0.92 mmol/L]),观察到 TG 显着降低 (P<0.001)。HDL 从基线 (45±13 mg/dL [1.16±0.34 mmol/L]) 增加到随访 (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05)。TG 与 HDL 的比率在随访时从基线的 4.07±2.41 提高到 2.48±1.26(P<0.001)。结论 观察到体重、BMI、HbA1c、TG 和 TG 与 HDL 的比率降低。在临床环境中改善了患者结果,并支持全民覆盖以增加患者获得 DSME 和 MNT 的机会。HDL 从基线 (45±13 mg/dL [1.16±0.34 mmol/L]) 增加到随访 (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05)。TG 与 HDL 的比率在随访时从基线的 4.07±2.41 提高到 2.48±1.26(P<0.001)。结论 观察到体重、BMI、HbA1c、TG 和 TG 与 HDL 的比率降低。在临床环境中改善了患者结果,并支持全民覆盖以增加患者获得 DSME 和 MNT 的机会。HDL 从基线 (45±13 mg/dL [1.16±0.34 mmol/L]) 增加到随访 (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05)。TG 与 HDL 的比率在随访时从基线的 4.07±2.41 提高到 2.48±1.26(P<0.001)。结论 观察到体重、BMI、HbA1c、TG 和 TG 与 HDL 的比率降低。在临床环境中改善了患者结果,并支持全民覆盖以增加患者获得 DSME 和 MNT 的机会。
更新日期:2019-03-01
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