TY - JOUR
T1 - Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes
AU - Kulkarni, Karmeen
AU - Castle, Gay
AU - Gregory, Rebecca
AU - Holmes, Alberta
AU - Leontos, Carolyn
AU - Powers, Margaret
AU - Snetselaar, Linda
AU - Splett, Patricia
AU - Wylie-Rosett, Judith
N1 - Funding Information:
This project was made possible by an educational grant from PACE (Partnership to Advance Care and Education; Eli Lilly and Company, Boehringer Mannheim, and Becton Dickinson), matching funds from the Diabetes Care and Education dietetic practice group, and the generous contribution of lime arui effort by field test dietitians and their patients.
PY - 1998/1
Y1 - 1998/1
N2 - Objectives: Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA(1C)); compare patient satisfaction with care and perceptions about quality of life. Design: Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA(1C) levels, and patient satisfaction and perceptions about quality of life. Subjects/settings: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods. Statistical analysis χ2 Test, t test, and analysis of covariance. Results: Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA(1C) improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA(1C) level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful. Conclusions/applications: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care or perceived quality of life.
AB - Objectives: Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA(1C)); compare patient satisfaction with care and perceptions about quality of life. Design: Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA(1C) levels, and patient satisfaction and perceptions about quality of life. Subjects/settings: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods. Statistical analysis χ2 Test, t test, and analysis of covariance. Results: Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA(1C) improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA(1C) level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful. Conclusions/applications: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care or perceived quality of life.
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U2 - 10.1016/S0002-8223(98)00017-0
DO - 10.1016/S0002-8223(98)00017-0
M3 - Comment/debate
C2 - 9434653
AN - SCOPUS:0031983992
SN - 0002-8223
VL - 98
SP - 62
EP - 70
JO - Journal of the American Dietetic Association
JF - Journal of the American Dietetic Association
IS - 1
ER -