Diabetes Type 1 and 2

DM: MNT (2007)

Additional questions related to MNT and Diabetes can be found in the Medical Nutrition Therapy project.

• Intervention
  How effective is MNT provided by Registered Dietitians in the management of persons with type 1 and type 2 diabetes?

  • Conclusion

    MNT has its greatest impact at diagnosis of diabetes.  Eight studies evaluating the effectiveness of diabetes MNT at three to six months, reported reductions in A1C, ranging from 0.25% to 2.9%, depending on the type and duration of diabetes. Individual sessions ranging from one to five or a series of 10 to 12 group sessions were employed. A variety of nutrition therapy interventions, such as a reduced energy and fat intake, carbohydrate counting, simplified meal plans, healthy food choices, individualized meal planning strategies, exchange lists, insulin-to-carbohydrate ratios and behavioral strategies were implemented. The number of initial and follow-up sessions varies in all the studies.  Studies reporting on effectiveness of MNT from six to twelve months  report a variety in the number and type of MNT sessions that lead to improved outcomes. Therefore, the RD needs to determine what is appropriate for individual clients.  Seven studies report sustained improvements in A1C at 12 months and longer. All involved regular sessions with an RD, ranging from monthly to three sessions per year. Seven studies report improvements in other outcomes, such as improved lipid profiles, weight management, decreased need for medications and reduced risk for onset and progression of comorbidities.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: How effective is MNT provided by Registered Dietitians in the management of type 1 and type 2 diabetes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ash S, Reeves MM, Yeo S, Morrison G, Carey D, Capra S. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. International Journal of Obesity. 2003; 27:797-802. 
      • Banister NA, Jastrow ST, Hodges V, Loop R, Gillham MB. Diabetes self-management training program in a community clinic improves patient outcomes at modest cost. J Am Diet Assoc 2004;104(5):807-10.
      • Bray P, Thompson D, Wynn JD, Cummings DM, Whetstone L. Confronting Disparities in Diabetes Care: The clinical effectiveness of redesigning care management for minority patients in rural primary care practices. J Rural Health 2005; 21(4):317-21.
      • Chima CS, Farmer-Dziak N, Cardwell P, Snow S. Use of technology to track outcomes in a diabetes self-management program. J Am Diet Assoc 2005; 105(12):1933-8.
      • DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. Brit Med J. 2002; 325:746-751.
      • The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.  
      •  Delahanty LM, et al. J Am Diet Assoc. 1998; 98: 28-30.
      • Franz MJ, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze RS.  Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus:  a randomized controlled clinical trial.  J Am Diet Assoc 1995;95:1009-1017.
      • Gaetke LM, Stuart MA, Truszczynska H. A single nutrition counseling session with a registered dietitian improves short-term clinical outcomes for rural Kentucky patients with chronic disease. J Am Diet Assoc 2006;106(1):109-112.
      • Goldhaber-Fiebert JD, Goldhaber-Fiebert SN, Tristan ML, Nathan DM. Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care 2003; 26:24-29.
      • Graber AL, Elasy TA, Quinn D, Wolff K, Brown A. Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices. South Med J 2002; 95(7):684-90.
      • Laitinen JH, Ahola IE, Sarkkinen ES, Winberg RL, Harmaakorpi-Livonen PA, Uusitupa MI. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1993;93(3):276-283.
      • Lemon CC, Lacey K, Lohse B, Hubacher DO, Klawitter B, Palta M. Outcomes monitoring of health, behavior, and quality of life after nutrition intervention in adults with type 2 diabetes. J Am Diet Assoc 2004; 104(12):1085-15.
      • Maislos M, Weisman D, Sherf M. Western Negev Mobile Diabetes Care Program: a model for interdisciplinary diabetes care in a semi-rural setting. Acta Diabetol 2002; 39(1):49-53.
      • Miller CK, Edwards L, Kissling G, Sanville L. Nutrition education improves metabolic outcomes among older adults with diabetes mellitus:results from a randomized controlled trial. Prev Med 2002;34(2):252-9.
      • Monk A, Barry B, McClain K, Weaver T, Cooper N, Franz MJ.  Practice guidelines for medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995;95:999-1006.
      • Wilson C, Brown T, Acton K, Gilliland A. Effects of clinical nutrition education and educator discipline on glycemic control outcomes in the Indian Health Service. Diabetes Care 2003; 26(6):2500-04.
      • Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler JL, Oneida B, Bovbjerg VE. Translating Lifestyle Intervention to Practice in Obese Patients with Type 2 Diabetes: Improving Control with Activity and Nutrition (ICAN) study. Diabetes Care, 2004; 27 (7): 1,570-1,576.
  • Search Plan and Results: Effectiveness of MNT by RDs 2006