Abstract
Background: Diet is central to treatment of type 2 diabetes. It is unclear if nutrition therapy provided by accredited dietitians achieves different outcomes to nutrition advice by other healthcare professionals. We compared the effectiveness of nutrition therapy by dietitians to advice from other healthcare professionals in adults with type 2 diabetes on clinical parameters. Methods: We conducted a systematic review and meta-analysis of type 2 diabetes management programmes implementing nutrition therapy. We searched Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO for randomised controlled trials in adults, of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528. Findings: Of 2477 records identified, fourteen studies (n = 3338) were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were -0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m2, -1·49 [-2·14, -0·84] kg, -0·15 [-0·33, 0·04] mmol/L, -0·75 [-2·45, 0·96] mm Hg and -1·17 [-4·52, 2·17] mm Hg respectively in favour of the intervention group. Heterogeneity was considerable as expected when combining data from a range of healthcare systems. Interpretation: Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across diverse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.
Highlights
Diet is central to treatment of type 2 diabetes
Type 2 diabetes mellitus has emerged as a global epidemic, affecting around half a billion people, with an estimated cost in excess of $1·3 trillion. 1–3 Nutrition therapy is central for the treatment of type 2 diabetes, due to its beneficial effects on regulating glucose concentrations and other metabolic parameters, as well as facilitating weight control in synergy with physical activity. 4,5
Individuals with type 2 diabetes may receive their nutritional advice from other healthcare professionals, for example physicians,[9,10,11] despite global reports highlighting a lack of nutrition education in medical curricula.[12,13]
Summary
Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters.
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