A Multisite Study Demonstrating the Efficacy and Potential Cost Savings of Diabetes Self-Management Education and Medical Nutrition Therapy in the Management of Type 2 Diabetes in Alabama
Type of DegreeMaster's Thesis
DepartmentNutrition, Dietetics and Hospitality Management
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Alabama has one of the highest prevalence rates of Type 2 Diabetes (T2D) impacting greater than 13.5% of the adult population. While diabetes self-management education (DSME) and medical nutrition therapy (MNT) has been shown to promote glycemic control and reduce risk of comorbidities and related healthcare expenditures, access to these services is limited due to poor reimbursement and lack of public policy directives. The project aims were to 1) document outcomes for patients with T2D completing DSME and MNT through 4 American Diabetes Association (ADA)-recognized diabetes education programs in Alabama and 2) identify potential healthcare cost-savings associated with reduction in HbA1c utilizing patient outcomes and mathematical models from published studies. A retrospective chart review was conducted of patients with T2D receiving DSME and MNT through four regional ADA-recognized diabetes education programs in Alabama. Baseline, end-of-program, and 1-year follow-up measures were queried for weight, body mass index (BMI), HbA1c, and lipids. Mixed-model analysis of variance was used to determine differences between means for continuous variables; McNemar’s test was used to assess frequency of patients reaching glycemic targets. Significant reductions were observed at end-of-program and 1-year in weight (2.67 kg, P<0.001; 2.25 kg, P = 0.001), BMI (0.93, P < 0.001; 0.76, P = 0.001), HbA1c (1.82%, P<0.001; 1.22%, P<0.001). Patients managed by diet alone had a baseline HbA1c of 6.95% and exhibited a 0.80% reduction in HbA1c; comparatively those managed with diet plus drug therapy had a baseline HbA1c of 9.00% and exhibited a 2.09% reduction in HbA1c at end-of-program. This study reports actual patient outcomes achieved in the clinical setting. Reductions were observed in key outcome measures weight, BMI and HbA1c. Cost-effective analysis of averting or delaying comorbid disease supports universal reimbursement and patient access to DSME with supplemental individualized MNT.