796-P: A Systematic Review of Diabetes-Related Outcomes in Food Provision Studies

In 2017, U.S. diabetes direct and productivity-related costs were $327 billion and accounted for 4 million deaths, yet much of this could be prevented by adhering to dietary guidelines. The objective was to perform a systematic review of the nutritional intervention literature where meals were provided to determine their clinical and cost impact in diabetes therapy. CINAHL, Cochrane, Health Source, and MEDLINE/PubMed were searched for food-provision articles published between January 1, 2013-May 1, 2018. Two researchers independently performed critical appraisal. Of 351 articles, appraisal was completed for 33 articles (N=14,258) that consisted of diets related to low caloric/carbohydrate intake or specific nutrients. Low calorie/carbohydrate diets consistently and significantly (p<0.017) reduced weight (>5% weight loss: 97.6%-100%; body-mass index loss: 2.3-5.4 kg/m2), waist circumference reduction (4.8-12cm), and improved markers of diabetes (A1c: 0.9-1.5% reduction) in short time frames (3 weeks-1 year). Patients reported higher dietary satisfaction (up to 93%) while achieving adequacy or 100% compliance. Large-scale education-based dietary interventions have challenges with patient adherence, yet resulted in 31.4% of patients moving from diabetes to prediabetes and 16.1% from prediabetes to none in 3 months. Other large-scale non-food provision studies (N=96,553) observed when patients improved A1c control (from 13.2% >9%A1c to 9.2% >9%A1c; p=0.01), hospitalization days were reduced by 2% annually (800,000 days) and $1.8 billion saved annually in the U.S. In this systematic review, A1c was significantly reduced by 0.9-1.5% (p<0.05) within weeks to months. Providing guideline-based culinary medicine prescriptions for medically tailored, goal-based meals may reduce healthcare costs by improving patient adherence and clinical outcomes; resulting in significant cost savings to the U.S. healthcare system, in reduced hospitalizations and/or overall direct costs.