DM: MNT (2007)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

Nutrition Practice Guidelines for individuals with non-insulin dependent diabetes mellitus were developed to define care (medical nutrition therapy or MNT by an RD) that is medically necessary and appropriate and consistently leads to the desired outcomes.

Inclusion Criteria:
None specifically mentioned.
Exclusion Criteria:
None specifically mentioned.
Description of Study Protocol:

Recruitment

Not specified.

Design

Consensus Report.

Blinding Used (if applicable)

Not applicable.

Intervention (if applicable)

Not applicable.

Statistical Analysis

Statistical analysis not completed.

Data Collection Summary:

Timing of Measurements

Not specified - consensus report.

Dependent Variables

Not specified - consensus report.

Independent Variables

Not specified - consensus report.

Control Variables

Description of Actual Data Sample:

Initial N:  not specified

Attrition (Final N):  not specified

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:

Summary of Results:

Other Findings

Practice guidelines for MNT provided by the RD to patient with NIDDM may be used for providing MNT for those who are newly diagnosed or for ongoing nutrition intervention for those whose MNT is only diet, diet + oral agents or diet + insulin or when there is a change in medical therapy such as an addition or change in medication.

After implementation of practice guidelines, patients with NIDDM should have ongoing MNT every 6 to 12 months.

Desired outcomes of MNT for patients with type 2 diabetes mellitus

Index Goal Desired outcome 4-6 wk after initial MNT
Glucose (mmol/L)    
    FBG 4.4 – 6.7 decrease by ~10%
    2-hr 5.6 – 10.0  
HbA1c (%) 6.6 – 7.5 decrease by ~10%
Cholesterol <5.2 mmol/L decrease by 6 – 12% if elevated
Blood Pressure <130/85 mm Hg  
Weight

Maintain reasonable Weight

decrease ½- 1 lb/wk or 5 to 20 lb total

decrease by 3-6 lb
Food/meal Planning

Meals/snacks eaten on regular basis

Appropriate choices and amounts based on food plan

If intake > needs, decrease by ~250-500 kcal/d

positive change in food selection, amounts, and frequency
Exercise If no medical limitations >=10-15 minutes/day, 3-4 x/wk Time and frequency gradually increased

 

1.Before initial visit

Obtain minimal referral data: Diabetes treatment plan, laboratory values, physician goals, medical history, medications that affect nutrition therapy, Guidelines for exercise

2. Initial visit (60 to 90 minutes)     

Assessment: (medical, lifestyle, psychosocial issues)

Intervention: nutrition prescription, education, goal setting

Communication: Team members and summary to referral source

3. 1st follow-up visit (within 2 wk of initial visit; minimum time of 30 –45 minutes)

Assessment: Progress towards stated short-term goals

Intervention: Changes in MNT, ongoing nutrition skills and education.

Communication: team members and summary to referral source

4. 2nd follow-up visit (within 2 to 4 wk of the first follow-up visit; minimum time of 30-45 minutes)

5. On-going follow-up visits (Minimum of 1 visit every 6 to 12 months)

Assessment: Progress to target blood glucose goals.

Intervention: Make MNT changes; recommend medical therapy changes as needed.

Communication: Long-term goals & plans for on-going care; summary to referral source.

Nutrition Practice Guidelines for type 2 diabetes mellitus (time and frequency)
Author Conclusion:

Nutrition Practice Guidelines can be used to anticipate and simplify decisions that would otherwise have to be made on a case-by-case basis by individual dietitians.

Nutrition practice guidelines for persons with NIDDM focus on specific actions and outcomes that make a difference in most persons with NIDDM. The guidelines provide dietitians with a consistent framework in which MNT can be individualized to meet the patient’s needs and goals and which integrates MNT into systems of total diabetes care.

Funding Source:
Reviewer Comments:

The recommended amount of time and frequency for visit with the RD are:

1. Initial visit: 60 to 90 minutes

2. 2 follow up visits within the first 6 wk after the initial visit for 30 to 45 minutes for each visit or a total of 60 to 90 minutes for 2 follow-up visits.

3. On-going follow-up visits as needed to meet MNT goals every 6 to 12 months or 1 to 2 times/year

~30-45 minutes for each visit or 60 minutes to 90 minutes per year.

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? N/A
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  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? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes