Education and Human Sciences, College of (CEHS)

 

Date of this Version

5-2013

Comments

A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Science, Major: Nutrition, Under the Supervision of Professors Julie A. Albrecht and Nancy M. Lewis. Lincoln, Nebraska: May 2013

Copyright (c) 2013 Charlene M. Dorcey

Abstract

Objective: Describe the impact of Medical Nutrition Therapy on health parameters of newly diagnosed patients with pre-diabetes in a rural Nebraska primary care clinic.

Background: Lifestyle interventions, including weight loss, exercise and diet, have a significant impact on diabetes prevention. Medical Nutrition Therapy (MNT) provided by a Registered Dietitian Nutritionist (RDN) is an essential part of any intervention approach. Several visits with an RDN have shown effective results. However, multiple visits become prohibitive, especially in rural areas, due to inaccessibility and cost when not covered by insurance.

Methods: This 2010 retrospective study of electronic health records examined newly diagnosed pre-diabetes patients who received (n=20, mean age 61, 85% female) or did not receive MNT (NMNT) (n=22, mean age 63, 82% female) in a 12 month time period after diagnosis. Health parameters (weight, Body Mass Index (BMI), fasting blood glucose (FBG), Hemoglobin A1C (A1C), lipids, blood pressure) were collected at baseline and repeat measurements were recorded from health records as close to one-year post diagnosis as available. Data were analyzed using Chi Square and Mixed Procedure.

Results: After adjusting for medications, greater weight loss and BMI change were observed and expected to continue in those who received MNT, although the difference was not significant. (P >0.05). The MNT group had a significant predicted decrease from baseline to time 2 in FBG (P=0.036), in A1C (P=0.05) and an increase of nearly 4 mg/dl (P=0.028) in HDL cholesterol (HDL-C). The NMNT group experienced approximately a 50 mg/dl decrease in triglyceride levels (P=0.05) but also had unexpected medication starts or dosage increases (P=0.01). Other lipid and blood pressure changes were not significant.

Conclusions: Patients with pre-diabetes receiving limited MNT provided by a RDN had positive changes in body weight and BMI, a lowering of FBG and A1C, and improved HDL-C after a year post diagnosis, and less medication starts or changes than patients without MNT.

Advisors: Julie A. Albrecht and Nancy M. Lewis