EAL

DM: MNT (2007)

Citation:

Delahanty LM, et al.

J Am Diet Assoc. 1998;

98: 28-30.

Worksheet created prior to Spring 2004 using earlier ADA research analysis template.

Study Design:

Narrative Review

Class:

R - Click here for explanation of classification scheme.

Quality Rating:

POSITIVE: See Quality Criteria Checklist below.

Research Purpose:

Inclusion Criteria:

Exclusion Criteria:

Description of Study Protocol:

Data Collection Summary:

Description of Actual Data Sample:

Summary of Results:

Diabetes Control and Complications Trial (DCCT)

1. This trial demonstrated conclusively that intensive diabetes therapy aimed at near normoglycemia effectively delays the onset and slows the progression of the long-term complications of type 1 diabetes.

2. The DCCT Research Group recommended that a comprehensive team provide intensive diabetes therapy using the expertise of dietitians, nurses, behaviorists, and physicians to ensure safe and effective treatment.

3. Recognition of the importance of diet in achieving HbA_1cgoals in the DCCT provided dietitians with the opportunity to expand and redefine their role in intensive diabetes therapy.

The study demonstrated that adherence to certain dietary behaviors was associated with a 1 unit lower HbA_1clevel.

Results from the DCCT study showed that for every 10% ? in HbA1c, the risk for progression of retinopathy ? by 43%. For every 10% ? in HbA1c, the risk of developing retinopathy by 66%, for developing microalbumnuria by 29% and for developing 43% for developing clinical neuropathy.

Clinical significance of field test results of Nutrition Practice Guidelines (NPG) for Type 1 diabetes mellitus:

MNT implemented according to the guidelines resulted in significantly greater reductions in HbA1c levels at 3 months than usual care (-1.00 vs. -.033). The mean HbA1c level of patients who received NPG care ? from 9.15 to 8.15 compared to those with basic nutrition care which ? from 9.53 to 9.2.

After 3 months of following the NPG, the patients achieved an 11% ? in HbA1c.

Clinical implications for dietitians:

1. Dietitians using the NPG were more likely than those provided basic nutrition care to:

a. pay greater attention to glycemic control goals at the first visit.

b. do an assessment and discuss results with the patient on the first visit.

c. spend more time with the patients; the first visit was about an hour for dietitians using NPG and 30 minutes for dietitians providing basic nutrition care.

2. More comprehensive assessments that integrate blood glucose data, food records, and changes in activity level and insulin doses take more time.

Next steps for dietitians :

1. Dietitians need to:

a. collect, organize, and present research and clinical practice data that adds to the evidence that MNT affects diabetes outcomes.

b. use the NPG for type 1 diabetes.

c. document to the patient, referring physician, and third-party payer that MNT affects diabetes outcome.

d. conduct audits to the degree to which MNT NPG are being followed and the outcomes.

e. use the results of field-testing of the NPG for type 1 diabetes to patients, primary care physicians, and third-party payers.

Author Conclusion:

If dietitians follow the NPG for type 1 diabetes mellitus and document outcomes, patients will increasingly request dietitian services from their physician and third-party payers. Likewise, physicians and insurers will increasingly allocate resources and referrals to dietitians for their patients who have diabetes.

The field-testing of the NPG for type 1 diabetes was for only 3 months. Similar studies of longer duration are needed.

Funding Source:

University/Hospital:

Massachusetts General Hospital

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	4.	Will the information, if true, require a change in practice?	Yes

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	No
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	No
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	Yes
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	No
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	No
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes