Intensive Medical Nutrition Therapy Integrated With Nurse and Physician Programs Improves Diabetic Clinical Outcomes

Abstract

Previously, dietitians did not collect outcomes data on diabetic patients seen at our facility. An average of 50 diabetic patients were seen per month in our clinic. Patients attended an initial diabetes class, but attendance was poor at the follow-up class. The dietitian collaborated with diabetic nurse educators and endocrinologists for an integrated and improved nutrition education program. The new program requires patients to attend an initial nutrition class and receive general diabetes information, followed by either a weight management class or a carbohydrate counting session. Next, patients have an option to choose from four special topic courses on label reading; exercise and snacking; sugars and sweeteners; and medication and glucose monitoring. The dietitian then encourages patients to return for individual follow-up appointments at least every 3 months. The dietitian began collecting outcomes data, tracking initial, 1-month and 3-month GH levels and clinic attendance. Initially, GH levels ranged from 8-14% prior to intensive medical nutrition therapy. Data collected over a 6 month period revealed that 57% of patients experienced at least a 10% decrease in GH within 4 weeks of initial training and 63% had GH levels ⩽7.5% at the 3 month follow up. GH levels were inversely correlated with clinic attendance, indicating better metabolic control when patients receive more intensive monitoring and follow-up with the dietitian. In addition, findings suggest that patient satisfaction significantly increased and clinic attendance improved over 100% with the implementation of our new program. Over 100 diabetic patients are now attending our nutrition classes monthly. Dietitians are an integral member of the diabetes team to provide intensive medical nutrition therapy for improved clinical outcomes.