Nutrition Practice Guidelines for Type 1 Diabetes Mellitus Positively Affect Dietitian Practices and Patient Outcomes

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Abstract

Objectives Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life.

Design Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life.

Subjects/settings Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods.

Statistical analysis χ2 Test, t test, and analysis of covariance.

Results Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (−1.00 vs −0.33). This difference was statistically significant and clinically meaningful.

Conclusions/applications Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care or perceived quality of life. J Am Diet Assoc. 1998;98:62-70.

Section snippets

Design and Sample Size

The study used an outcomes research approach (16), (17), (18) to compare the new practice guidelines nutrition care with usual nutrition care provided by dietitians to patients with type 1 diabetes over a 3-month period in a range of practice settings across the United States. Volunteer dietitians were assigned randomly to a practice guidelines group or a usual care group; then all patients seen by a dietitian at the health care setting received either practice guidelines care or usual care as

Description of Field-Test Dietitians

A total of 97 dietitians responded to recruitment efforts and were sent field-test information. The 51 who signed consent forms agreeing to participate were assigned randomly as follows: 24 to the usual care group and 27 to the practice guidelines group. Of these 51 dietitians, 27 (14 in the usual care group and 13 in the practice guidelines group) were able to enroll patients with type 1 diabetes. Reasons for dietitians’ withdrawal from participation included time limitations because of job

Discussion

The field test was planned using an outcomes research approach. Nutrition care provided in accordance with the new practice guidelines was compared with “usual nutrition care” provided by dietitians to persons with type 1 diabetes. We made no attempt to define the elements or amount of usual care, as we wanted to determine whether systematic and consistent care as outlined in the practice guidelines document was qualitatively different and whether it produced quantitatively better outcomes than

Applications

Nutrition Practice Guidelines for Type 1 Diabetes Mellitus outline a process that can lead to more effective MNT. This field test provides evidence that ongoing contact between dietitians and patients is important to help patients initiate and maintain self-management of diabetes. The guidelines define progressive levels of care from initial contact to ongoing continuing or intensive care. Defined numbers of visits and recommended ranges for contact time can be used to plan clinic schedules. In

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    Copyright © 1998 American Dietetic Association. Published by Elsevier Inc. All rights reserved.