Massachusetts General Hospital Diabetes Center, 50 Staniford St Suite 340, Boston, MA 02114, USA.
J Hum Nutr Diet. 2010 Aug;23(4):360-70. doi: 10.1111/j.1365-277X.2010.01065.x. Epub 2010 Apr 27.
Nutrition and lifestyle interventions have been a critical component in three of the four largest clinical trials that focused on diabetes in the past two decades. Evidence of the effectiveness of nutrition and lifestyle interventions with resepect to achieving diabetes-related outcomes for diabetes prevention and a reduction in diabetes complications for people with diabetes is clearly mounting. The Diabetes Control and Complications Trial (1983-1993), the Diabetes Prevention Program (1996-2001) and the Look AHEAD (Action for Health in Diabetes) Trial (2001-2012) have been providing key evidence for the dietitian's role in delivering effective nutrition and lifestyle interventions for people with prediabetes, type 1 and type 2 diabetes. The dietitians in these multicentre efficacy trials contributed to this evidence base by expanding their roles beyond implementing the protocol defined goal-based nutrition and lifestyle interventions to conducting ancillary research and using problem-solving strategies that tailor counselling approaches toward participants' barriers to goal achievement. As lifestyle coaches and case managers, dietitians had the opportunity to work with the same group of study participants over extended periods of time and use their clinical and research expertise to uncover important insights and strategies that helped achieve clinical goals related to glycaemia control, weight loss and activity. The present review will 'chart the course' of how the evidence base for nutrition and lifestyle interventions emanated from these trials and discuss the implications for clinical dietetic practice. Dietitians can use insights gleaned from these experiences with the research process to expand their roles and guide cutting edge evidence-based clinical dietetic practice in diabetes.
营养和生活方式干预一直是过去二十年中四项最大的糖尿病临床试验中的三项的关键组成部分。有证据表明，营养和生活方式干预在预防糖尿病和减少糖尿病并发症方面对糖尿病患者的相关结果具有有效性。糖尿病控制和并发症试验（1983-1993 年）、糖尿病预防计划（1996-2001 年）和 LOOK AHEAD（糖尿病中的健康行动）试验（2001-2012 年）一直在为营养师在为糖尿病前期、1 型和 2 型糖尿病患者提供有效的营养和生活方式干预方面的作用提供关键证据。这些多中心疗效试验中的营养师通过将其角色从实施基于目标的营养和生活方式干预方案扩展到进行辅助研究并使用解决问题的策略来针对参与者实现目标的障碍来调整咨询方法，从而为这一证据基础做出了贡献。作为生活方式教练和病例经理，营养师有机会在较长时间内与同一组研究参与者合作，并利用他们的临床和研究专业知识来发现有助于实现与血糖控制、减肥和活动相关的临床目标的重要见解和策略。本综述将“描绘”营养和生活方式干预的证据基础如何从这些试验中产生，并讨论对临床饮食实践的影响。营养师可以从这些研究经验中汲取的见解来扩展他们的角色，并指导基于最新证据的前沿临床饮食实践。
