Davidson J K, Delcher H K, Englund A
J Am Diet Assoc. 1979 Sep;75(3):250-7.
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.
八年前，在亚特兰大的格雷迪纪念医院照顾糖尿病患者时，优先使用口服降糖药和胰岛素，对营养的关注极少。1971年，制定了一项“扩展营养护理计划”，重点是营养教育和随访。停用了口服降糖药，自1972年以来，胰岛素的使用量也减少了。新的饮食计划由营养师发挥关键作用，包括为期一周的完全禁食、严格的低热量饮食、个性化的饮食规划和指导，以及仔细的随访监测。1971年以前和目前的对比数据显示：下肢截肢减少了50%，糖尿病酮症酸中毒减少，住院次数减少，体重减轻40%而血浆葡萄糖没有升高（在一个有完整随访的127名患者队列中），并且八年来医院在药物成本上节省了超过9.6万美元，在住院费用上节省了370万美元。
