To Evaluate the Effectiveness of Medical Nutrition Therapy for Patients with Diabetes Mellitus

Angela Tang Dietetic Department United Christian Hospital

May 9, 2005

Medical Nutrition Therapy

Definition
an illness, injury, or condition It involves TWO phases:
1. assessment of nutritional status and the therapeutic needs of the patient 2. treatment which includes nutrition therapy, counseling, and the use of nutritional supplements (ADA, 1994)

The use of specific nutrition services to treat

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

Patients
TOTAL 370 patients (Initial Attendance)

233 patients (1st follow-up)

STUDY GROUP 158 patients attended both 1st and 2nd follow-up

Patients
40%

Sex Distribution
Male Female 60%

BMI<18.5 1%

18.5<BMI<22.9

15%

BMI Distribution

BMI<18.5 18.5BMI22.9 BMI23

BMI>23 84%

Analyses of Data (paired t test)

Initial Initial Follow-up (pre-edn) (post-edn) Same day 4 months later
Nutrition Knowledge Body Mass Index (BMI) Diet Compliance Clinical Parameters

Results Body Weight

Comparison of Body Weight 69 68.5 68 kg 67.5 67 66.5 66 Initial Follow-up 67.1 Body Weight 68.6

N = 133 p<0.001

Results Body Mass Index

Comparison of BMI 27.4 27.4 27.2

kg/m

27 26.8 26.6 26.4 Initial

26.8 BMI

Follow-up

N = 133 p<0.001

Results Nutrition Knowledge Score

Comparison of Nutrition Knowledge Score

90 80 70 60 50 % 40 30 20 10 0

83.7 67.8

Nutrition Knowledge Score

Pre-edn

Post-edn

N = 158 p<0.001

Results Diet Compliance Score

Comparison of Diet Compliance Score 50 40 30 % 20 10 0 Initial Follow-up
Diet Compliance Score

44.8 29.5

N = 158 p<0.001

Results Diet Compliance Score

Comparison of Diet Compliance Score
Diet Control Only/ Static Dosage of Medication

50 40 30 % 20 10 0 Initial 29.6 30.1

44.4 45.3

DM Group N = 120 Lipid Group N = 141

Follow-up

p<0.001

Results Clinical Outcome Parameters

Comparison of Fasting Blood Sugar
Diet Control Only/ Static Dosage of Medication

9 8.5 mmol/L 8 7.5 7

8.6

7.6 FBS Initial Follow-up

N = 49 p<0.05

Results Clinical Outcome Parameters

Comparison of Glycosylated Haemoglobin
Diet Control Only/ Static Dosage of Medication

8.5 8.5 8 % 7.5 7 6.5 7.3 HbA1c

N = 43 p<0.001

Initial

Follow-up

Results Clinical Outcome Parameters

Comparison of Serum Lipid
Diet Control Only/ Static Dosage of Medication

7 6 5 4 3 2 1 0

6.25 5.50 3.48 4.01

TC
N=16 p<0.05
3.03 3.23

mmo l/L

TG
N=8 p=0.589

LDLC
N=23 p<0.01

Initial

Follow-up

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 microvascular complications 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 EFFECTIVE Prevent/delay onset Management of DM of long-term Cx

Anthropometric Measurements Nutrition Knowledge Questionnaire

Diet Compliance Clinical Outcome Markers

Thank you