Prospective Randomized Controlled Trial to Evaluate Effectiveness of Registered Dietitian–Led Diabetes Management on Glycemic and Diet Control in a Primary Care Setting in Taiwan
Open accessAbstract
OBJECTIVE: In this randomized controlled trial we evaluated the effect of registered dietitian–led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures. RESEARCH DESIGN AND METHODS: We recruited 154 adult patients with type 2 diabetes and randomly assigned them to a routine care control group (n = 79) or a registered dietitian–led intervention group (n = 75) who received on-site diabetic self-management education every 3 months over 12 months. RESULTS: Over the 1-year period, neither the intervention group (n = 75) nor the control group (n = 79) had significant changes in A1C, whereas the intervention patients with poorly controlled baseline A1C (≥7%) (n = 56) had significantly greater improvements in A1C and fasting plasma glucose than the control subjects (n = 60) (−0.7 vs. −0.2%, P = 0.034; −13.4 vs. 16.9 mg/dl, P = 0.007) during the same period. We also found significant net intervention-control group differences in overall energy intake (−229.06 ± 309.16 vs. 56.10 ± 309.41 kcal/day) and carbohydrate intake (−31.24 ± 61.53 vs. 7.15 ± 54.09 g/day) (P < 0.001) in patients with poorly controlled A1C. Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and A1C in the intervention group (n = 56; β = 0.10, SEM = 0.033, P = 0.004). CONCLUSIONS: On-site registered dietitian–led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan. A reduction in carbohydrate intake may improve glycemic status.
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Seventeen studies targeting diabetes reported mean changes in HbA1c, with seven reporting significant improvements in the intervention compared with usual care.
“Seventeen studies targeting diabetes reported mean changes in HbA1c, with seven reporting significant improvements in the intervention compared to usual care”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [46]
The Results (Clinical parameters; page unavailable) report a significant improvement in mean A1C versus controls, but only among participants with poorly controlled baseline A1C; there was no significant improvement for the full trial population. This single trial does not report the cited totals of 17 studies and seven significant findings. (LLM, conf=0.86)
Experimental — accuracy not yet measuredForty-four RCTs examined the impact of interventions on disease-specific outcomes.
“Forty four RCTs examined the impact of interventions on disease specific outcomes”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [46]
The Research Design and Methods and Results sections describe one randomized trial assessing diabetes-specific outcomes, including A1C and fasting glucose. The paper does not report that 44 RCTs examined disease-specific outcomes, so it cannot substantiate the stated count. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe association between the use of GLP-1 receptor agonists and the risk of acute pancreatitis is negative.
“The association between the use of GLP‐1 receptor agonists and the risk of acute pancreatitis has been shown to be negative 25 , 26 , 27 , 28 , 29 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [25]
Psychological/behavioral approaches are effective in diabetes management.
“Psychological/behavioral approaches have been shown to be effective in diabetes management 24 , 25 (grade A: 95% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [25]
The use of fibrates reduces the risk of non-fatal cardiovascular disease in patients with diabetes and dyslipidemia.
“The use of fibrates has been shown to reduce the risk of non‐fatal CVD in patients with diabetes and dyslipidemia 24 , 25 , 26 , 27 , 28 (grade B: 88% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [25]
Addition of sugar or artificial sweeteners in drinks is associated with an increased risk of type 2 diabetes.
“Addition of not only sugar but artificial sweeteners in drinks is associated with an increased risk of type 2 diabetes 25 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [25]
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- Authors
- Huang, M.-C., Hsu, C.-C., Wang, H.-S., & Shin, S.-J.
- Affiliations
- Kaohsiung Medical University (TW)
- National Health Research Institutes (TW)
- Kaohsiung Medical University Chung-Ho Memorial Hospital (TW)
- Corresponding author
- Shin, Shyi-Jang
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-11-12
- Volume
- 33
- Issue
- 2
- Pages
- 233-239
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2809255
- OpenAlex
- W2150701468
- Cited by
- 122
- References
- 26
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 9 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 7 · 2017: 11 · 2016: 9 · 2015: 8 · 2014: 8 · 2013: 13 · 2012: 9
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, glycemic control, HbA1c, carbohydrate intake, macronutrient intake, energy intake, primary care, fasting blood glucose, uncontrolled diabetes
- MeSH terms
- Adult, Aged, Blood Glucose, Blood Pressure, Energy Intake, Diabetes Mellitus, Diet, Diabetic, Dietary Carbohydrates, Educational Status, Fasting, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Patient Education as Topic, Taiwan, Body Mass Index, Patient Selection, Diabetes Complications
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