Abstract

Objective - This randomized controlled trial evaluated the effect of a registered dietitian (RD)-led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures.

Research Design And Methods - We recruited 154 adult patients with type 2 diabetes and randomly assigned them to a routine care control group (n=79) or an RD-led intervention group (n=75) who received on-site diabetic self-management education every three months over 12 months.

Results - Over the one year period, neither the intervention group (n=75) nor the control group (n=79) had significant changes in HbA1c, while the intervention patients with poorly controlled baseline HbA1c(>7%) (n=56) had significantly greater improvements in HbA1c and fasting plasma glucose than the controls (n=60) (−0.7 vs. −0.2%, p=0.034; −13.4 vs. 16.9mg/dl, p=0.007) during the same period. We also found significant net intervention-control group differences in overall energy intake (−229.06+309.16 vs. 56.10+309.41kcal/day) and carbohydrate intake (−31.24+61.53 vs. 7.15+54.09 g/day) (p<0.001) in patients with poorly controlled HbA1c. Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and HbA1c in the intervention group (n=56, beta=0.10; SE=0.033; p=0.004).

Conclusions- On-site RD-led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan. A reduction in carbohydrate intake may improve glycemic status.