Npe4 3
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Transcript of Npe4 3
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To Evaluate the Effectiveness of
Medical Nutrition Therapyfor Patients with Diabetes Mellitus
Angela TangDietetic Department
United Christian Hospital
May 9, 2005
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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
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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
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DCCT & UKPDS
♦Both indicated that tight control of blood glucose can prevent or delay long-term complications of DM
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Methods
♦Retrospective study
♦Type 2 DM adult patients
♦Referred by all specialties for MNT
♦Between January 1 and July 31, 2004(for initial consultations)
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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
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Dietary Compliance Scoring System
♦Balanced Diet♦Portion Control♦Cooking Methods♦Eating-out Choices♦Food Label Recognition♦Alcohol Consumption♦Physical Activities♦Hypoglycemia Recognition & Management
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TOTAL 370 patients
(Initial Attendance)
STUDY GROUP
158 patients
attended both 1st and 2nd follow-up
Patients
233 patients
(1st follow-up)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Discussion
Improved Outcomes (Statistically Significant)
♦Body Weight/Body Mass Index
♦Nutrition Knowledge
♦Dietary Compliance
♦Clinical Parameters (FBS, HbA1c, TC & LDLC)
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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)
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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
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CONCLUSION
MEDICAL NUTRITION THERAPY
Management of DMPrevent/delay onset
of long-term Cx
Nutrition Knowledge
Questionnaire
Diet
Compliance
Anthropometric
Measurements Clinical
Outcome
Markers
EFFECTIVE
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Thank you
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