Abstract
Purpose: The purpose of this systematic review is to discuss the ideal frequency of Registered Dietitian-Nutritionist (RDN) contact required to improve glycemic control in patients with type 2 diabetes in the primary care setting.
Methods: Researchers completed a literature search between April 1 and June 30, 2020. Researchers identified 184 studies and included seven studies for full-text analysis. Eligible studies were required to occur in a primary care setting, use A1C as an outcome measure, and use some form of education or contact with an RDN. Study quality was assessed using the NIH Study Quality Assessment Tool.
Results: Compared to the usual care group of each study, increased contact with an RDN improved A1C lowering regardless of frequency (round-the-clock, monthly, biannually). The largest decreases occurred in the round-the-clockand quarterly touch groups. Studies varied in modality (inperson, telehealth, etc.) and type of intervention. The participants had A1Cs between 8.07% and 10.25% before intervention. With RDN contact of any frequency between provider visits and participants saw A1Cs decreased between 0.66% and 2.2%.
Conclusion: Greater glycemic control in patients with type 2 diabetes in the primary care environment is linked to more frequent RDN contact than that advised by the American Diabetes Association Standards of Care.
Keywords: Diabetes, dietetics, nutrition, type II diabetes, type 2 diabetes, medical nutrition therapy, MNT, dietitian, diabetes educator, registered dietitian-nutritionist, nutritionist.
[1]
Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns 2016; 99(6): 926-43.
[http://dx.doi.org/10.1016/j.pec.2015.11.003] [PMID: 26658704]
[http://dx.doi.org/10.1016/j.pec.2015.11.003] [PMID: 26658704]
[2]
Dobrow L, Estrada I, Burkholder-Cooley N, Miklavcic J. Potential effectiveness of registered dietitian nutritionists in healthy behavior interventions for managing type 2 diabetes in older adults: A systematic review. Front Nutr 2022; 8: 737410.
[http://dx.doi.org/10.3389/fnut.2021.737410] [PMID: 35141261]
[http://dx.doi.org/10.3389/fnut.2021.737410] [PMID: 35141261]
[3]
Powers MA, Bardsley JK, Cypress M, et al. Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American diabetes association, the association of diabetes care & education specialists, the academy of nutrition and dietetics, the American academy of family physicians, the American academy of PAs, the American association of nurse practitioners, and the American pharmacists association. Diabetes Care 2020; 43(7): 1636-49.
[http://dx.doi.org/10.2337/dci20-0023] [PMID: 32513817]
[http://dx.doi.org/10.2337/dci20-0023] [PMID: 32513817]
[4]
Franz MJ, MacLeod J, Evert A, et al. Academy of nutrition and dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults: Systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process. J Acad Nutr Diet 2017; 117(10): 1659-79.
[http://dx.doi.org/10.1016/j.jand.2017.03.022] [PMID: 28533169]
[http://dx.doi.org/10.1016/j.jand.2017.03.022] [PMID: 28533169]
[5]
Siopis G, Colagiuri S, Allman-Farinelli M. Efficacy of nutrition counseling by a dietitian in improving clinical outcomes for people with type 2 diabetes mellitus: A systematic review and meta-analysis of RCTs. Curr Dev Nutr 2020; 4 (Supplemet_2): 281.
[http://dx.doi.org/10.1093/cdn/nzaa043_132]
[http://dx.doi.org/10.1093/cdn/nzaa043_132]
[6]
Chaudhury A, Duvoor C, Reddy Dendi VS, et al. Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Front Endocrinol (Lausanne) 2017; 8: 6.
[http://dx.doi.org/10.3389/fendo.2017.00006] [PMID: 28167928]
[http://dx.doi.org/10.3389/fendo.2017.00006] [PMID: 28167928]
[7]
Decision memo for medical nutrition therapy benefit for diabetes & ESRD (CAG-00097N). Available from: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=53&fromdb=true (Accessed March 13, 2021).
[8]
Coverage for Diabetes Self-Management Training. Available from: https://www.medicare.gov/coverage/diabetes-self-management-training (Accessed on: March 13, 2021).
[9]
Group TDPP. The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care 2002; 25(12): 2165-71.
[http://dx.doi.org/10.2337/diacare.25.12.2165] [PMID: 12453955]
[http://dx.doi.org/10.2337/diacare.25.12.2165] [PMID: 12453955]
[10]
Lindström J, Louheranta A, Mannelin M, et al. The finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26(12): 3230-6.
[http://dx.doi.org/10.2337/diacare.26.12.3230] [PMID: 14633807]
[http://dx.doi.org/10.2337/diacare.26.12.3230] [PMID: 14633807]
[11]
Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20-year follow-up study. Lancet 2008; 371(9626): 1783-9.
[http://dx.doi.org/10.1016/S0140-6736(08)60766-7] [PMID: 18502303]
[http://dx.doi.org/10.1016/S0140-6736(08)60766-7] [PMID: 18502303]
[12]
Davidson JA. The increasing role of primary care physicians in caring for patients with type 2 diabetes mellitus. Mayo Clin Proc 2010; 85(12): S3-4.
[http://dx.doi.org/10.4065/mcp.2010.0466] [PMID: 21106869]
[http://dx.doi.org/10.4065/mcp.2010.0466] [PMID: 21106869]
[13]
Ross J, Stevenson FA, Dack C, et al. Health care professionals’ views towards self-management and self-management education for people with type 2 diabetes. BMJ Open 2019; 9(7): e029961.
[http://dx.doi.org/10.1136/bmjopen-2019-029961] [PMID: 31315874]
[http://dx.doi.org/10.1136/bmjopen-2019-029961] [PMID: 31315874]
[14]
Mehta S, Mocarski M, Wisniewski T, Gillespie K, Narayan KMV, Lang K. Primary care physicians’ utilization of type 2 diabetes screening guidelines and referrals to behavioral interventions: A survey-linked retrospective study. BMJ Open Diabetes Res Care 2017; 5(1): e000406.
[http://dx.doi.org/10.1136/bmjdrc-2017-000406] [PMID: 28878936]
[http://dx.doi.org/10.1136/bmjdrc-2017-000406] [PMID: 28878936]
[15]
Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: A systematic review of randomized controlled trials. J Acad Nutr Diet 2017; 117(12): 1941-62.
[http://dx.doi.org/10.1016/j.jand.2017.06.364] [PMID: 28826840]
[http://dx.doi.org/10.1016/j.jand.2017.06.364] [PMID: 28826840]
[16]
Tang PC, Overhage JM, Chan AS, et al. Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc 2013; 20(3): 526-34.
[http://dx.doi.org/10.1136/amiajnl-2012-001263] [PMID: 23171659]
[http://dx.doi.org/10.1136/amiajnl-2012-001263] [PMID: 23171659]
[17]
King DE, Petrone AB, Alcantara FM, et al. Outcomes in an interdisciplinary diabetes clinic in rural primary care. South Med J 2019; 112(4): 205-9.
[http://dx.doi.org/10.14423/SMJ.0000000000000960] [PMID: 30943537]
[http://dx.doi.org/10.14423/SMJ.0000000000000960] [PMID: 30943537]
[18]
Marincic PZ, Hardin A, Salazar MV, Scott S, Fan SX, Gaillard PR. Diabetes self-management education and medical nutrition therapy improve patient outcomes: A pilot study documenting the efficacy of registered dietitian nutritionist interventions through retrospective chart review. J Acad Nutr Diet 2017; 117(8): 1254-64.
[http://dx.doi.org/10.1016/j.jand.2017.01.023] [PMID: 28330731]
[http://dx.doi.org/10.1016/j.jand.2017.01.023] [PMID: 28330731]
[19]
Benson GA, Sidebottom A, Hayes J, et al. Impact of ENHANCED (diEtitiaNs Helping pAtieNts CarE for diabetes) telemedicine randomized controlled trial on diabetes optimal care outcomes in patients with type 2 diabetes. J Acad Nutr Diet 2019; 119(4): 585-98.
[http://dx.doi.org/10.1016/j.jand.2018.11.013] [PMID: 30711463]
[http://dx.doi.org/10.1016/j.jand.2018.11.013] [PMID: 30711463]
[20]
Greenwood DA, Blozis SA, Young HM, Nesbitt TS, Quinn CC. Overcoming clinical inertia: A randomized clinical trial of a telehealth remote monitoring intervention using paired glucose testing in adults with type 2 diabetes. J Med Internet Res 2015; 17(7): e178.
[http://dx.doi.org/10.2196/jmir.4112] [PMID: 26199142]
[http://dx.doi.org/10.2196/jmir.4112] [PMID: 26199142]
[21]
Kesavadev J, Saboo B, Shankar A, Krishnan G, Jothydev S. Telemedicine for diabetes care: An Indian perspective - feasibility and efficacy. Indian J Endocrinol Metab 2015; 19(6): 764-9.
[http://dx.doi.org/10.4103/2230-8210.167560] [PMID: 26693425]
[http://dx.doi.org/10.4103/2230-8210.167560] [PMID: 26693425]
[22]
Mottalib A, Salsberg V, Mohd-Yusof BN, et al. Effects of nutrition therapy on HbA1c and cardiovascular disease risk factors in overweight and obese patients with type 2 diabetes. Nutr J 2018; 17(1): 42.
[http://dx.doi.org/10.1186/s12937-018-0351-0] [PMID: 29626933]
[http://dx.doi.org/10.1186/s12937-018-0351-0] [PMID: 29626933]
[23]
Telehealth: A post-COVID-19 reality? McKinsey Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality (Accessed on: April 26, 2021).
[24]
Shea S, Kothari D, Teresi JA, et al. Social impact analysis of the effects of a telemedicine intervention to improve diabetes outcomes in an ethnically diverse, medically underserved population: Findings from the IDEATel Study. Am J Public Health 2013; 103(10): 1888-94.
[http://dx.doi.org/10.2105/AJPH.2012.300909] [PMID: 23488491]
[http://dx.doi.org/10.2105/AJPH.2012.300909] [PMID: 23488491]
[25]
Alvarado MM, Kum HC, Gonzalez Coronado K, Foster MJ, Ortega P, Lawley MA. Barriers to remote health interventions for type 2 diabetes: A systematic review and proposed classification scheme. J Med Internet Res 2017; 19(2): e28.
[http://dx.doi.org/10.2196/jmir.6382] [PMID: 28193598]
[http://dx.doi.org/10.2196/jmir.6382] [PMID: 28193598]
[27]
McWhorter JW, Danho MP, LaRue DM, et al. Barriers and facilitators of implementing a clinic-integrated food prescription plus culinary medicine program in a low-income food insecure population: A qualitative study. J Acad Nutr Diet 2021; S2212-2672(21)01509-4.
[http://dx.doi.org/10.1016/j.jand.2021.11.016] [PMID: 34839026]
[http://dx.doi.org/10.1016/j.jand.2021.11.016] [PMID: 34839026]
