Spin-off cost/benefits of expanded nutritional care.

Eight years ago, in caring for persons with diabetes at Grady Memorial Hospital, Atlanta, priority was given to the use of oral hypoglycemic agents and insulin, with only minimal attention to nutrition. In 1971, an "expanded nutritional care program" was instituted, with emphasis on nutritional education and follow-up. Use of oral agents was discontinued, and, since 1972, less insulin has been used. The new dietary program, with dietitians playing a key role, includes a one-week total fast, stringent low-calorie diets, individualized dietary planning and instruction, and careful follow-up monitoring. Comparative pre-1971 and current data show: a 50 per cent reduction in lower extremity amputations, less diabetic ketoacidosis, fewer hospitalizations, weight reduction of 40 per cent with no increase in plasma glucose (in a 127-patient cohort with complete follow-up), and a savings to the hospital of more than $96,000 in the cost of medications and $3,700,000 in hospitalizations in eight years.