J Acad Nutr Diet. 2019 Apr;119(4):585-598. doi: 10.1016/j.jand.2018.11.013. Epub 2019 Jan 31.
Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.
To investigate the efficacy of a registered dietitian nutritionist-led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.
A randomized controlled trial in which participants were assigned to a control or intervention group.
PARTICIPANTS/SETTING: One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.
For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.
Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.
Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.
A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.
ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care.
尽管 2 型糖尿病的临床护理水平有所提高，但仍不理想。协作式、以团队为基础的模式可以最大限度地发挥不同学科的技能，从而改善糖尿病患者的护理，但很少有研究使用严格的研究设计来检验这些模式。
通过随机对照试验，研究注册营养师主导的远程医疗项目与对照组相比，在实现糖尿病最佳护理目标方面的效果。
参与者被随机分配到对照组或干预组的随机对照试验。
参与者/设置：2016 年 4 月至 2017 年 12 月期间，118 名 2 型糖尿病成年人（平均年龄 60 岁；45%为女性）参与了这项研究。参与者来自明尼苏达州两个农村社区的两个独立初级保健诊所招募而来。
对于被分配到干预组的患者，注册营养师使用治疗方案来启动和调整血糖、高血压和血脂水平的治疗方法，此外还提供医学营养治疗；远程医疗就诊补充了常规护理。
主要结局包括复合和个别糖尿病最佳护理目标：糖化血红蛋白、血压、不吸烟、服用他汀类药物和阿司匹林（视情况而定）。次要措施包括身体活动、早餐、水果和蔬菜、全谷物、体重指数、低密度脂蛋白和药物依从性。
采用混合模型回归分析方法比较基线和 1 年随访时的结果。
干预组在随访时达到的糖尿病最佳护理措施数量略有但显著增加（干预组为 3.7，对照组为 3.2[P=0.017]）。在个别措施方面，干预组的药物使用显著增加，服用他汀类药物的几率分别高出 2.5 倍（对照组为 1.0 至 6.24）[95%CI，1.0 至 6.24]）和阿司匹林（对照组为 0.90 至 5.19[95%CI，0.90 至 5.19]）的几率也显著更高。
ENHANCED（营养师帮助患者管理糖尿病）的研究结果表明，遵循药物治疗方案的注册营养师可以有效改善 2 型糖尿病患者的护理，并且可以作为医疗保健团队的一部分，发挥提供基于证据、以患者为中心的护理的重要作用。
