Franz M J, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze R S
International Diabetes Center, Park Nicollet Medical Foundation, Minneapolis, Minn 55416, USA.
J Am Diet Assoc. 1995 Sep;95(9):1009-17. doi: 10.1016/S0002-8223(95)00276-6.
To assess the effect of medical nutrition therapy (MNT) provided by dietitians on medical and clinical outcomes for adults with non-insulin-dependent diabetes mellitus (NIDDM), and to compare MNT administered according to practice guidelines nutrition care (PGC) to MNT administered with basic nutrition care (BC).
A prospective, randomized, controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states (Minnesota, Florida, and Colorado). BC consisted of a single visit with a dietitian; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period. Data were collected at entry to the study and at 3 and 6 months.
Results are reported for 179 men and women aged 38 to 76 years: 85 assigned randomly to BC and 94 to PGC. This represents 72% of the 247 subjects enrolled. An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonrandom comparison group.
Medical outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and serum lipid levels. Clinical outcomes included weight, body mass index, waist-to-hip ratio, and changes in medical therapy.
Initial analysis of the discrete variables was done using the chi 2 statistic with Yates' correction. Initial analysis of continuous variables was done by analysis of variance. The changes in variables between time periods were analyzed by paired t test, and comparisons between groups were analyzed using a t test for independent groups.
At 6 months, PGC resulted in significant improvements in blood glucose control as indicated by FPG and HbA1c levels and BC resulted in significant improvements in HbA1c level. Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5% lower than the level at entry, and those in the BC group had a 5.3% lower value. Among subjects who had diabetes for longer than 6 months, those who received PGC had a significantly better HbA1c level at 3 months compared with those receiving BC. The comparison group showed no improvement in glycemic control over a comparable 6 months. PGC subjects had significant improvements in cholesterol values at 6 months, and subjects in both the PGC and the BC groups had significant weight loss.
MNT provided by dietitians resulted in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM. Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC. Because of the upward trend in glucose levels after 3 months, ongoing MNT by dietitians is important for long-term metabolic control.
评估营养师提供的医学营养治疗（MNT）对非胰岛素依赖型糖尿病（NIDDM）成人患者的医学及临床结局的影响，并比较依据实践指南营养护理（PGC）实施的MNT与基础营养护理（BC）实施的MNT。
在三个州（明尼苏达州、佛罗里达州和科罗拉多州）的糖尿病中心，针对新诊断或正在接受NIDDM治疗的患者，开展了一项关于两种水平MNT对代谢控制影响的前瞻性、随机、对照临床试验。BC包括与营养师进行一次就诊；PGC包括与营养师进行一次初诊，随后在研究期的前6周内再进行两次就诊。在研究开始时以及3个月和6个月时收集数据。
报告了179名年龄在38至76岁之间的男性和女性的结果：85人被随机分配至BC组，94人被分配至PGC组。这占所招募的247名受试者的72%。在一个研究点，另外62名未与营养师接触的NIDDM成年患者被确定为非随机比较组。
医学结局指标包括空腹血糖（FPG）、糖化血红蛋白（HbA1c）和血脂水平。临床结局包括体重、体重指数、腰臀比以及药物治疗的变化。
离散变量的初始分析使用带有耶茨校正的卡方统计量。连续变量的初始分析通过方差分析进行。时间段之间变量的变化通过配对t检验进行分析，组间比较使用独立组t检验进行分析。
在6个月时，PGC组在FPG和HbA1c水平方面显示出血糖控制有显著改善，BC组在HbA1c水平方面有显著改善。被分配至PGC组的参与者在6个月时的平均FPG水平比入组时低10.5%，BC组的参与者则低5.3%。在患糖尿病超过6个月的受试者中，接受PGC的受试者在3个月时的HbA1c水平显著优于接受BC的受试者。比较组在类似的6个月期间血糖控制没有改善。PGC组受试者在6个月时胆固醇值有显著改善，PGC组和BC组的受试者体重均显著减轻。
营养师提供的MNT在BC组和PGC组均使医学及临床结局有显著改善，对NIDDM患者有益。糖尿病病程超过6个月的患者接受PGC往往比接受BC效果更好。由于3个月后血糖水平呈上升趋势，营养师持续进行MNT对长期代谢控制很重要。
