This document summarizes a study evaluating the effectiveness of medical nutrition therapy for patients with diabetes mellitus. The study found that after receiving nutrition therapy, patients had significant improvements in body weight/BMI, nutrition knowledge, diet compliance, and clinical markers like fasting blood sugar, HbA1c, and cholesterol levels. These positive outcomes indicate that medical nutrition therapy is an effective approach for managing diabetes and preventing long-term complications by helping patients make beneficial dietary changes and lifestyle modifications.

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. 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. 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. DCCT & UKPDS
♦Both indicated that tight control of
blood glucose can prevent or delay
long-term complications of DM

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. 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. Dietary Compliance Scoring System
♦ Balanced Diet
♦ Portion Control
♦ Cooking Methods
♦ Eating-out Choices
♦ Food Label Recognition
♦ Alcohol Consumption
♦ Physical Activities
♦ Hypoglycemia Recognition & Management

8. Patients
TOTAL
370 patients
(Initial Attendance)
233 patients
(1st follow-up)
STUDY GROUP
158 patients
attended both 1st and 2nd follow-up

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Discussion
Improved Outcomes (Statistically Significant)
♦ Body Weight/Body Mass Index
♦ Nutrition Knowledge
♦ Dietary Compliance
♦ Clinical Parameters (FBS, HbA1c, TC & LDLC)

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. 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. 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. Thank you