Franz Marion J, MacLeod Janice
Nutrition Concepts by Franz, Minneapolis, MN.
Clinical Innovation, WellDoc, Columbia, MD, USA.
Diabetes Metab Syndr Obes. 2018 Jun 11;11:265-270. doi: 10.2147/DMSO.S141952. eCollection 2018.
A systematic review was conducted by the Academy of Nutrition and Dietetics to determine the evidence for the effectiveness of individualized nutrition therapy provided by a dietitian nutritionist and evidence-based (EB) nutrition-therapy interventions in adults with diabetes. This article briefly reviews the systematic process used and summarizes the effectiveness evidence and intervention recommendations. In persons with type 2 diabetes (T2D), 18 studies met study criteria for the effectiveness question. A 0.3%-2.0% decrease from baseline in glycated hemoglobin was reported at 3 months in 13 study arms, a 0.3%-1.8% decrease at 6 months in 12 study arms, a 0.3%-1.6% decrease at 12 months with ongoing support in six study arms, and a 0.6%-1.8% decrease at >12 months in four study arms. An initial series of encounters with follow-up visits and implementation of a variety of nutrition-therapy interventions, all of which reduced energy intake, were reported. Nutrition therapy also significantly decreased doses or number of glucose-lowering medications used and resulted in improvements in quality of life. Mixed effects on cardiovascular risk factors and body weight were reported. Fourteen questions were identified related to nutrition-therapy interventions. A total of 38 studies met study criteria for the nutrition-intervention questions, from which 30 conclusion statements and 19 nutrition-practice guideline recommendations for T2D were written. Three additional NPG recommendations for T2D were written based on evidence reviewed by the American Diabetes Association. The 22 nutrition-intervention recommendations for T2D are summarized. How to implement nutrition-practice guideline recommendations effectively by health care providers and individuals with T2D remains challenging. Of importance, it is recognized that identifying and integrating EB digital health-technology tools into clinical practice are major challenges for future management of diabetes, self-management education, and support.
营养与饮食学会开展了一项系统评价，以确定注册营养师提供的个体化营养治疗以及循证营养治疗干预措施对成年糖尿病患者有效性的证据。本文简要回顾了所采用的系统过程，并总结了有效性证据和干预建议。在2型糖尿病（T2D）患者中，有18项研究符合有效性问题的研究标准。13个研究组在3个月时糖化血红蛋白较基线水平下降了0.3%-2.0%，12个研究组在6个月时下降了0.3%-1.8%，6个研究组在12个月持续支持下下降了0.3%-1.6%，4个研究组在超过12个月时下降了0.6%-1.8%。报告了一系列初始问诊及随访，并实施了多种营养治疗干预措施，所有这些措施均降低了能量摄入。营养治疗还显著降低了降糖药物的剂量或使用数量，并改善了生活质量。报告了对心血管危险因素和体重的混合影响。确定了14个与营养治疗干预措施相关的问题。共有38项研究符合营养干预问题的研究标准，从中撰写了30条结论声明和19条T2D营养实践指南建议。基于美国糖尿病协会审查的证据，又撰写了3条T2D营养实践指南建议。总结了22条T2D营养干预建议。医疗保健提供者和T2D患者如何有效实施营养实践指南建议仍然具有挑战性。重要的是，人们认识到识别并将循证数字健康技术工具整合到临床实践中是糖尿病未来管理、自我管理教育和支持的主要挑战。
