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  1. 1. Summary & Appraisal of: Medical Nutrition Therapy: A Key toDiabetes Management and Prevention Cyril Cybon Shadha Anvar Ismail Patiguli Niazy Somayyeh Firouzi
  2. 2. Diabetes Mellitus• Defenition Diabetes mellitus is a chronic disease caused by inherited and or acquired deficiency in production of insulin by the pancrease, or by ineffectiveness of the insulin produced due to insulin resistance.• WHO criteria for diagnosis of diabetes Symptoms of diabetes plus casual venous plasma glucose.11.1 mmol/l Fasting plasma glucose.7.0 mmol/l or whole blood.6.1mmol/l. fasting is defined as no calorie intake for at least 8 hours. 2 hours plasma glucose.11.1mmol/l oral glucose tolerance test using 75g glucose load. (Watkins 2003)
  3. 3. DIAGNOSTIC TEST Venous Capillary whole Venous whole blood blood plasma Diabetes mellitus >6.1 ⪰6.1 ⪰7.0 Fasting ⪰10.0 ⪰11.1 ⪰11.1 2 hours after glucose load****************** Impaired glucose <6.1 <6.1 <7.0 tolerance Fastiong ⪰6.7 ⪰7.8 ⪰7.82 hours after glucose <10.0 11.1 11.1 load (Watkins 2003)
  4. 4. Types of diabetes• Type 1• Type 2• Gestational diabetes• Diabetes due to other diseases
  5. 5. MEDICAL NUTRITION THERAPY• Medical nutrition therapy (MNT) is a cornerstone of treatment for the estimated millions people with diabetes in the world. (Tomuta et al.2009)• Historically patients referred to their physician for addressing their nutritional queries.• Medical Nutrition Therapy for diabetes has undergone dramatic change over the past century .
  6. 6. a Amount is based on nutritional assessment and treatment goals.b Less than 10% of kcalories from saturated fats.Source: American Diabetes Association (1997). (Robinson and Beck)
  7. 7. Outcome studies lead to development of MNT• In order to improve diabetes care, the ADA has developed evidence-based nutrition recommendations that are implemented in MNT (American Diabetes Association, 2002a&b).• Recent researches showed that MNT, administered by a RD or nutrition professionals, is a key component of diabetes management
  8. 8. Defining MNT:Nutritional diagnostic, therapy, and counseling services for the purpose of disease management, which are furnished by a registered dietitian or nutrition professional.The goals of MNT:• To achieve and maintain: – Normoglycemia, – Lipid profiles within normal limits, – Blood pressure levels within normal limits.• To prevent and treat complications of diabetes.• To improve health with appropriate food choices and physical activity.• To address the needs of individuals with sensitivity to cultural/ethnic preferences. ( Robinson and Beck)
  9. 9. Nutrition screening/referral Theframework Nutrition assessment of an RD Nutrition diagnosis Nutrition intervention Nutrition monitoring and evaluation Nutrition documentation Outcome management system
  10. 10. The differences between MNT & DSMT (diabetes self-management training) MNT DSMTmore individualized diagnosis, therapy, and An education and training program counseling related to nutrition. That helps to manage diabetesseveral sessions with an RD , relies heavily One hour individual assessment and 9 on follow up and feedback hour group assessment More intensive nutritional counseling Consists of educating nutritional management, life style as well as medication safety and so onCan be done only by a licensed/certified RD Can be done by nurse, or nutrition professional dietitian, or pharmacist Administered after DSMT Administered before MNT
  11. 11. conclusion• MNT plays a central role in the care of diabetic patients.• a well-designed nutritional plan is an essential component of the therapeutic regimen for all diabetics• MNT benefits patients with all forms of diabetes and it is the single most important intervention for the prevention and probably treatment for type 2 diabetics• All members of the team involved in a diabetic patient’s care should be involved in setting nutrition-related goals, but it is highly recommended that a registered dietitian assumes the coordinating role in MNT education and management.• Achieving nutrition-related goals requires the efforts of a multidisciplinary team.• MNT plays an important role in three major areas of diabetes : primary prevention, to improve glycemic control and prevent diabetes related complications; and tertiary prevention to help prevent morbidity and mortality (Kordonouri et al.2009)
  12. 12. REFERENCES• Kordonouri ,O., Apovian ,C., Kuhn , L., Danne ,T.,and Mantzoros, C.,S. 2009. Medical Nutrition Therapy in the Treatment of Type 1 and Type 2 Diabetes.• Pastors,J.G., Warshaw, h., Daly, A., Franz, M. & Kulkarni, K. 2002. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes care, 25, 3,608-613• Robinson, C.M. & Beck, J. nutrition for individuals with diabetes.• Watkins, P.J., 2003. ABC of diabetes.BMJ books. Watkins pub.p:1