Improved long-term outcomes in high-risk patients receiving registered dietitian nutritionist care

Abstract

AimsRegistered dietitian nutritionists have been shown to improve weight and HbA1c in high-risk patients, yet little is known about these outcomes long term. MethodsElectronic medical records were reviewed for participants 18 years or older with BMI≥35 kg/m2 or HbA1c≥7.0% at first visit to a patient-centered medical home in Boston, Massachusetts. 1,902 patients met BMI criteria, and 1,240 met HbA1c criteria. Mean change in weight (kg) and HbA1c (%) at six, 12, and 24 months were compared between patients who saw an RDN and patients who received primary care alone. Paired sample t-tests and repeated measures ANOVA adjusting for age, sex, gender, days from baseline at follow-up, and number of visits at follow-up were used to analyze outcomes. ResultsMean weight loss was greater in the RDN group at all time points. HbA1c decreased significantly with RDN care at all time points (P<0.001). Patients with at least one RDN visit had significantly greater mean change in HbA1c of -0.8 ±0.2 (95% CI -1.0 to -0.5) and -0.6 ±0.1 (95% CI -0.8 to -0.3) after 12 and 24 months from baseline, respectively (P<0.001). ConclusionsRDN care resulted in statistically and clinically significant improvements in HbA1c at 12 and 24 months compared to primary care and in significant weight loss up to 24 months.