Diabetes Self-Management Education (DSME) and Medical Nutrition Therapy (MNT) for Type 2 Diabetes Improves Patient Outcomes: A Retrospective Chart Review

Abstract

Background Diabetes self-management education (DSME) and Medical Nutrition Therapy (MNT) improve patient outcomes; poor reimbursement limits access to care.

Objectives The aim was to develop methodology for tracking patient outcomes subsequent to registered dietitian nutritionist interventions, document outcomes for patients with type 2 diabetes (T2D) attending an American Diabetes Association (ADA)-recognized education program, and obtain outcome data to support reimbursement and public policy initiatives to improve patient access to DSME and MNT.

Design Retrospective chart review.

Participants/setting A random sample of 100 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSME and individualized MNT, June 2013- June 2014.

Statistical Analysis Mixed model analysis of variance was used to determine differences between means for continuous variables; McNemar tests and Gamma statistic trend analysis were used to assess frequency of patients reaching glycemic targets.

Results Significant weight loss was observed from baseline (94.3±21.1kg) to end of program (91.7±21.2) [-1.6±3.9kg]; P<0.001); weight loss in whites (-5.0±8.4kg; P<0.001) exceeded that of African Americans (-0.8±9.0kg; (P>0.05). Significant hemoglobin A1c reduction was observed from baseline (8.74±2.30%) to end-of-program (6.82±1.37%) [-1.92±2.25%]; P<0.001) and retained at one-year (6.90±1.16%; P<0.001). Comparatively, 72% of patients reached hemoglobin A1c targets (≤7.0%) versus 27% at baseline (P=0.008). When stratified by diet alone and diet plus drug therapy, patients exhibited a 1.08±1.20% (P<0.001) and 2.36±2.53% (P<0.001) reduction in hemoglobin A1c respectively. Triglycerides decreased from baseline 181.6±75.5mg/dL (2.0±0.9mmol/L) to 115.8±48.1mg/dL (1.3±0.5mmol/L) (P=0.023). High density lipoprotein increased from 41.4±12.4mg/dL (1.1mmol/L±0.3) to 47.3±12.4mg/dL (1.2±0.3mmol/L) (P=0.007).

Conclusions Retrospective chart review provides an operational model for abstracting existing patient outcome data subsequent to registered dietitian nutritionist interventions. In support of universal reimbursement and patient access to DSME with supplemental individualized MNT, reductions were observed in the key outcome measures of weight, body mass index, hemoglobin A1c, and triglycerides, and increase was observed in HDL, suggesting a potential for reduction in cardiovascular risk from exposure to DSME and MNT.