Npe4 3

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Npe4 3

  1. 1. To Evaluate the Effectiveness of Medical Nutrition Therapy for Patients with Diabetes Mellitus Angela Tang Dietetic Department United Christian Hospital May 9, 2005
  2. 2. Medical Nutrition Therapy Definition (ADA, 1994) ♦ The use of specific nutrition services to treat an illness, injury, or condition ♦ It involves TWO phases: 1. assessment of nutritional status and the therapeutic needs of the patient 2. treatment which includes nutrition therapy, counseling, and the use of nutritional supplements
  3. 3. Medical Nutrition Therapy for DM Major Goals ♦ Achieve & maintain optimal blood glucose & lipid levels through appropriate food choices ♦ Empower persons to self-manage their DM by providing information to increase their knowledge & skills ♦ Provide adequate energy & nutrients for attaining &/or maintaining a reasonable weight for adults ♦ Prevent/delay the long term complications of DM
  4. 4. DCCT & UKPDS ♦Both indicated that tight control of blood glucose can prevent or delay long-term complications of DM
  5. 5. Methods ♦ Retrospective study ♦ Type 2 DM adult patients ♦ Referred by all specialties for MNT ♦ Between January 1 and July 31, 2004 (for initial consultations)
  6. 6. Medical Nutrition Therapy ♦ Nutritional Assessment – Anthropometrics (e.g. BW, BH, BMI) – Clinical Parameters – Nutrition Knowledge Questionnaire – Diet History ♦ Diet Education ♦ Goal Setting and Meal Plan ♦ Evaluation – Dietary Compliance Scoring System – Regular Follow-up
  7. 7. Dietary Compliance Scoring System ♦ Balanced Diet ♦ Portion Control ♦ Cooking Methods ♦ Eating-out Choices ♦ Food Label Recognition ♦ Alcohol Consumption ♦ Physical Activities ♦ Hypoglycemia Recognition & Management
  8. 8. Patients TOTAL 370 patients (Initial Attendance) 233 patients (1st follow-up) STUDY GROUP 158 patients attended both 1st and 2nd follow-up
  9. 9. Patients Sex Distribution Male 40% Female 60% BMI<18.5 1% 18.5<BMI<22.9 15% BMI Distribution BMI<18.5 BMI>23 84% 18.5≤BMI≤22.9 BMI≥23
  10. 10. Analyses of Data (paired t test) Initial Initial Follow-up (pre-edn) (post-edn) Same day 4 months later Nutrition Knowledge Body Mass Index (BMI) Diet Compliance Clinical Parameters
  11. 11. Results – Body Weight Comparison of Body Weight 69 68.6 68.5 68 67.1 kg 67.5 67 Body Weight 66.5 66 Initial Follow-up N = 133 p<0.001
  12. 12. Results – Body Mass Index Comparison of BMI 27.4 27.4 27.2 kg/m 2 27 26.8 BMI 26.8 26.6 26.4 Initial Follow-up N = 133 p<0.001
  13. 13. Results – Nutrition Knowledge Score Comparison of Nutrition Knowledge Score 90 80 70 60 50 % 40 30 20 10 0 83.7 67.8 Nutrition Knowledge Score Pre-edn Post-edn N = 158 p<0.001
  14. 14. Results – Diet Compliance Score Comparison of Diet Compliance Score 44.8 50 40 29.5 30 Diet Compliance Score % 20 10 0 Initial Follow-up N = 158 p<0.001
  15. 15. Results – Diet Compliance Score Comparison of Diet Compliance Score Diet Control Only/ Static Dosage of Medication 44.4 45.3 50 40 29.6 30.1 30 % DM Group N = 120 20 10 0 Initial Follow-up Lipid Group N = 141 p<0.001
  16. 16. Results – Clinical Outcome Parameters Comparison of Fasting Blood Sugar Diet Control Only/ Static Dosage of Medication 9 8.6 8.5 mmol/L 8 7.6 7.5 7 FBS Initial Follow-up N = 49 p<0.05
  17. 17. Results – Clinical Outcome Parameters Comparison of Glycosylated Haemoglobin Diet Control Only/ Static Dosage of Medication 8.5 8.5 8 7.3 % 7.5 HbA1c 7 6.5 Initial Follow-up N = 43 p<0.001
  18. 18. Results – Clinical Outcome Parameters Comparison of Serum Lipid Diet Control Only/ Static Dosage of Medication 7 mmo l/L 6 5 4 3 2 1 0 6.25 5.50 3.48 4.01 TC N=16 p<0.05 3.03 3.23 TG N=8 p=0.589 LDLC N=23 p<0.01 Initial Follow-up
  19. 19. Discussion Improved Outcomes (Statistically Significant) ♦ Body Weight/Body Mass Index ♦ Nutrition Knowledge ♦ Dietary Compliance ♦ Clinical Parameters (FBS, HbA1c, TC & LDLC)
  20. 20. Discussion ♦ ↓1.2% in HbA1c (DCCT: ↓ HbA1c by 2% reduces risk of onset & rate of progression of microvascular complications by 60%) ♦ ↓12% in TC & ↓ 19.5% in LDLC (NCEP:↓ TC by 1% reduces risk of coronary heart disease by 2%) ♦ ↓1.5 kg in 4 months – a promising start (ADA:↓ BW by 5-10% enhances insulin sensitivity and improves blood glucose levels)
  21. 21. Implications ♦ The use of Diet Compliance Scoring System and setting small, realistic & attainable goals have proven to be successful for promoting behavioral changes ♦ Data collected are also being input into the CMS(RO). This will enhance communication between physicians and dietitians to achieve holistic care for patients
  22. 22. CONCLUSION MEDICAL NUTRITION THERAPY EFFECTIVE Prevent/delay onset Management of DM of long-term Cx Anthropometric Diet Measurements Compliance Clinical Nutrition Knowledge Outcome Questionnaire Markers
  23. 23. Thank you

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