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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 months 3,042 newly diagnosed patients with type 2 diabetes In 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 months 179 persons with type 2 diabetes; 62 in comparison group; duration of diabetes: 4 years HbA1c 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 months 54 patients with type 1 diabetes; newly diagnosed HbA1c 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 months 162 type 2 diabetic patients over the age of 60 years HbA1c 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 months 185 adult patients with diabetes 97 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 years 623 patients with type 1 Patients 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 months 19 patients with type 2 diabetes At 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 year 162 adult patients MNT 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 months 102 patients (15 type 1 and 85 type 2 diabetic patients with duration of diabetes >6 months HbA1c levels decreased 1.6% (9.3 to 7.7%) after referral to an RD 
Meta-analyses of trials    
 Brown, 1996, 1990 (16, 17)  89 studies Educational intervention and weight loss outcomes; MNT had statistically significant positive impact on weight loss and metabolic control 
 Padgett et al., 1988 (18)  7,451 patients Educational and psychosocial interventions in management of diabetes (including MNT, SMBG, exercise, and relaxation); nutrition education showed strongest effect 
 Norris et al., 2001 (19)  72 studies Positive 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) 
Type of intervention (Reference)Study lengthNo. of subjectsOutcome
Randomized controlled trials    
MNT only    
 UKPDS Group, 1990 (5) 3 months 3,042 newly diagnosed patients with type 2 diabetes In 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 months 179 persons with type 2 diabetes; 62 in comparison group; duration of diabetes: 4 years HbA1c 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 months 54 patients with type 1 diabetes; newly diagnosed HbA1c 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 months 162 type 2 diabetic patients over the age of 60 years HbA1c 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 months 185 adult patients with diabetes 97 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 years 623 patients with type 1 Patients 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 months 19 patients with type 2 diabetes At 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 year 162 adult patients MNT 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 months 102 patients (15 type 1 and 85 type 2 diabetic patients with duration of diabetes >6 months HbA1c levels decreased 1.6% (9.3 to 7.7%) after referral to an RD 
Meta-analyses of trials    
 Brown, 1996, 1990 (16, 17)  89 studies Educational intervention and weight loss outcomes; MNT had statistically significant positive impact on weight loss and metabolic control 
 Padgett et al., 1988 (18)  7,451 patients Educational and psychosocial interventions in management of diabetes (including MNT, SMBG, exercise, and relaxation); nutrition education showed strongest effect 
 Norris et al., 2001 (19)  72 studies Positive 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) 
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