To Evaluate the Effectiveness of

Medical Nutrition Therapyfor Patients with Diabetes Mellitus

Angela TangDietetic Department

United Christian Hospital

May 9, 2005

Medical Nutrition Therapy

♦The use of specific nutrition services to treat an illness, injury, or condition

♦ It involves TWO phases:

1. assessment of nutritional status and thetherapeutic needs of the patient

Definition (ADA, 1994)

2. treatment which includes nutrition therapy,counseling, and the use of nutritionalsupplements

Medical Nutrition Therapy for DM

Major Goals

♦ Achieve & maintain optimal blood glucose & lipid levels through appropriate food choices

♦ Empower persons to self-manage their DM by providing information to increase their knowledge & skills

♦ Provide adequate energy & nutrients for attaining &/or maintaining a reasonable weight for adults

♦ Prevent/delay the long term complications of DM

DCCT & UKPDS

♦Both indicated that tight control of blood glucose can prevent or delay long-term complications of DM

Methods

♦Retrospective study

♦Type 2 DM adult patients

♦Referred by all specialties for MNT

♦Between January 1 and July 31, 2004(for initial consultations)

Medical Nutrition Therapy♦Nutritional Assessment

– Anthropometrics (e.g. BW, BH, BMI)

– Clinical Parameters– Nutrition Knowledge Questionnaire– Diet History

♦Diet Education♦Goal Setting and Meal Plan♦Evaluation

– Dietary Compliance Scoring System – Regular Follow-up

Dietary Compliance Scoring System

♦Balanced Diet♦Portion Control♦Cooking Methods♦Eating-out Choices♦Food Label Recognition♦Alcohol Consumption♦Physical Activities♦Hypoglycemia Recognition & Management

TOTAL 370 patients

(Initial Attendance)

STUDY GROUP

158 patients

attended both 1st and 2nd follow-up

Patients

233 patients

(1st follow-up)

Patients

60%

40%Male

Female

BMI>2384%

18.5<BMI<22.915%

BMI<18.51%

BMI<18.518.5≤BMI≤22.9BMI≥23

Sex Distribution

BMI Distribution

Analyses of Data (paired t test)

Diet Compliance

Clinical Parameters

Follow-upInitial (post-edn)

Initial (pre-edn)

Same day

Body Mass Index (BMI)

Nutrition Knowledge

4 months later

Results – Body Weight

68.6

67.1

66

66.5

67

67.5

68

68.5

69

kg

Initial Follow-up

Comparison of Body Weight

BodyWeight

N = 133p<0.001

Results – Body Mass Index

27.4

26.8

26.4

26.6

26.8

27

27.2

27.4

kg/m2

Initial Follow-up

Comparison of BMI

BMI

N = 133p<0.001

Results – Nutrition Knowledge Score

67.8

83.7

0

10

20

30

40

50

60

70

80

90

%

Pre-edn Post-edn

Comparison of Nutrition Knowledge Score

Nutrition Knowledge Score

p<0.001N = 158

Results – Diet Compliance Score

29.5

44.8

0

10

20

30

40

50

%

Initial Follow-up

Comparison of Diet Compliance Score

Diet ComplianceScore

p<0.001N = 158

Results – Diet Compliance Score

29.6 30.1

44.4 45.3

0

10

20

30

40

50

%

Initial Follow-up

Comparison of Diet Compliance Score

DM Group

Lipid Group

p<0.001

N = 120

N = 141

Diet Control Only/ Static Dosage of Medication

Results – Clinical Outcome Parameters

8.6

7.6

7

7.5

8

8.5

9

mmol/L

Initial Follow-up

Comparison of Fasting Blood Sugar

FBS

p<0.05N = 49

Diet Control Only/ Static Dosage of Medication

Results – Clinical Outcome Parameters

8.5

7.3

6.5

7

7.5

8

8.5

%

Initial Follow-up

Comparison of Glycosylated Haemoglobin

HbA1c

p<0.001N = 43

Diet Control Only/ Static Dosage of Medication

Results – Clinical Outcome Parameters

6.25

3.484.01

5.50

3.033.23

0

1

2

3

4

5

6

7

mmol/L

Initial Follow-up

Comparison of Serum Lipid

TC

TG

LDLC

N=16 p<0.05

N=23 p<0.01

N=8 p=0.589

Diet Control Only/ Static Dosage of Medication

Discussion

Improved Outcomes (Statistically Significant)

♦Body Weight/Body Mass Index

♦Nutrition Knowledge

♦Dietary Compliance

♦Clinical Parameters (FBS, HbA1c, TC & LDLC)

Discussion♦ ↓1.2% in HbA1c

(DCCT: ↓ HbA1c by 2% reduces risk of onset & rate of progression of microvascularcomplications by 60%)

♦ ↓12% in TC & ↓ 19.5% in LDLC(NCEP:↓ TC by 1% reduces risk of coronary heart disease by 2%)

♦ ↓1.5 kg in 4 months – a promising start(ADA:↓ BW by 5-10% enhances insulin

sensitivity and improves blood glucose levels)

Implications

♦The use of Diet Compliance Scoring System and setting small, realistic & attainable goals have proven to be successful for promoting behavioral changes

♦Data collected are also being input into the CMS(RO). This will enhance communication between physicians and dietitians to achieve holistic care for patients

CONCLUSION

MEDICAL NUTRITION THERAPY

Management of DMPrevent/delay onset

of long-term Cx

Nutrition Knowledge

Questionnaire

Diet

Compliance

Anthropometric

Measurements Clinical

Outcome

Markers

EFFECTIVE

Thank you