Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
Diabetes Care. 2010 Feb;33(2):233-9. doi: 10.2337/dc09-1092. Epub 2009 Nov 12.
In this randomized controlled trial we evaluated the effect of registered dietitian-led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures.
We recruited 154 adult patients with type 2 diabetes and randomly assigned them to a routine care control group (n = 79) or a registered dietitian-led intervention group (n = 75) who received on-site diabetic self-management education every 3 months over 12 months.
Over the 1-year period, neither the intervention group (n = 75) nor the control group (n = 79) had significant changes in A1C, whereas the intervention patients with poorly controlled baseline A1C (> or =7%) (n = 56) had significantly greater improvements in A1C and fasting plasma glucose than the control subjects (n = 60) (-0.7 vs. -0.2%, P = 0.034; -13.4 vs. 16.9 mg/dl, P = 0.007) during the same period. We also found significant net intervention-control group differences in overall energy intake (-229.06 +/- 309.16 vs. 56.10 +/- 309.41 kcal/day) and carbohydrate intake (-31.24 +/- 61.53 vs. 7.15 +/- 54.09 g/day) (P < 0.001) in patients with poorly controlled A1C. Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and A1C in the intervention group (n = 56; beta = 0.10, SEM = 0.033, P = 0.004).
On-site registered dietitian-led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan. A reduction in carbohydrate intake may improve glycemic status.
在这项随机对照试验中，我们评估了注册营养师主导的糖尿病管理对台湾基层医疗诊所 2 型糖尿病患者血糖控制和宏量营养素摄入的影响，并研究了宏量营养素摄入变化与血糖测量之间的关联。
我们招募了 154 名成年 2 型糖尿病患者，并将他们随机分配到常规护理对照组（n=79）或注册营养师主导的干预组（n=75），这些患者在 12 个月内每 3 个月接受一次现场糖尿病自我管理教育。
在 1 年期间，干预组（n=75）和对照组（n=79）的 A1C 均无显著变化，而基线 A1C 控制不佳（>或=7%）的干预患者（n=56）与对照组患者相比，A1C 和空腹血浆葡萄糖有显著改善（-0.7%对-0.2%，P=0.034；-13.4 对 16.9 mg/dl，P=0.007）。我们还发现，在 A1C 控制不佳的患者中，总能量摄入（-229.06±309.16 对 56.10±309.41 kcal/天）和碳水化合物摄入（-31.24±61.53 对 7.15±54.09 g/天）的干预组与对照组之间存在显著的净差异（P<0.001）。多变量调整模型显示，在 A1C 控制不佳的干预组患者中（n=56），碳水化合物摄入变化与 A1C 之间存在独立关联（β=0.10，SEM=0.033，P=0.004）。
现场注册营养师主导的糖尿病管理可以改善台湾基层医疗诊所 2 型糖尿病患者的血糖控制。减少碳水化合物摄入可能会改善血糖状态。
