Table 1—

Summary of evidence for nutrition therapy in diabetes

Type of intervention (Reference)Study lengthNo. of subjectsOutcome
Randomized controlled trials
MNT only
 UKPDS Group, 1990 (5)3 months3,042 newly diagnosed patients with type 2 diabetesIn 2,595 patients who received intensive nutrition therapy (447 were primary diet failures), HbA1c decreased 1.9% (8.9 to 7%) during the 3 months before study randomization
 Franz et al., 1995 (6)6 months179 persons with type 2 diabetes; 62 in comparison group; duration of diabetes: 4 yearsHbA1c at 6 months decreased 0.9% (8.3 to 7.4%) with nutrition practice guidelines care; HbA1c decreased 0.7% (8.3 to 7.6%) with basic nutrition care; HbA1c was unchanged in the comparison group with no nutrition intervention (8.2 to 8.4%)
 Kulkarni et al., 1998 (7)6 months54 patients with type 1 diabetes; newly diagnosedHbA1c at 3 months decreased 1.0% (9.2 to 8.2%) with nutrition practice guideline care and 0.3% (9.5 to 9.2%) in usual nutrition care group
MNT in combination with DSMT
 Glasgow et al., 1992 (8)6 months162 type 2 diabetic patients over the age of 60 yearsHbA1c decreased from 7.4 to 6.4% in control-intervention crossover group while the intervention-control crossover group had a rebound effect; intervention group had a multidisciplinary team with an RD who provided MNT
 Sadur et al., 1999 (9)6 months185 adult patients with diabetes97 patients received multidisciplinary care and 88 patients received usual care by primary care. MD; HbA1c decreased 1.3% in the multidisciplinary care group compared with 0.2% in the usual care group; intervention group had a multidisciplinary team with an RD who provided MNT
Observational studies
Cross-sectional survey
 Delahanty and Halford, 1993 (10)9 years623 patients with type 1Patients who reported following their meal plan >90% of the time had an average HbA1c level 0.9% lower than subjects who followed their meal plan <45% of the time
Expert opinion
 DCCT Research Group, 1993 (11)DCCT group recognized the importance of the role of the RD in educating patients on nutrition and adherence to achieve A1c goals; RD is key member of the team
 Franz, 1994 (12)DCCT made apparent that RDs and RNs were extremely important members of the team in co-managing and educating patients
Chart audit
 Johnson and Valera, 1995 (13)6 months19 patients with type 2 diabetesAt 6 months, blood glucose levels decreased 50% in 76 of patients receiving nutrition therapy by an RD. Mean total weight reduction was ∼5 pounds
 Johnson and Thomas, 2001 (14)1 year162 adult patientsMNT intervention decreased HbA1c levels 20%, bringing mean levels <8% compared with subjects without MNT intervention who had a 2% decrease in HbA1c levels
Retrospective chart review
 Christensen et al., 2000 (15)3 months102 patients (15 type 1 and 85 type 2 diabetic patients with duration of diabetes >6 monthsHbA1c levels decreased 1.6% (9.3 to 7.7%) after referral to an RD
Meta-analyses of trials
 Brown, 1996, 1990 (16, 17)89 studiesEducational intervention and weight loss outcomes; MNT had statistically significant positive impact on weight loss and metabolic control
 Padgett et al., 1988 (18)7,451 patientsEducational and psychosocial interventions in management of diabetes (including MNT, SMBG, exercise, and relaxation); nutrition education showed strongest effect
 Norris et al., 2001 (19)72 studiesPositive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months)