Diabetes Education, Dietitian Counseling Improve Diabetes Control

Diabetes education and dietitian counseling, without intervention by an endocrinologist, can improve glycemic control and promote weight loss in patients with Type 2 diabetes who also have poor literacy, according to a study.…

“This is one of few studies demonstrating a measurable improvement in diabetes control and weight loss which are solely due to diabetes education and diet counseling in a municipal hospital with limited resources,” said Issac Sachmechi, MD, Queen’s Hospital Center of Mount Sinai School of Medicine, Jamaica, New York, during a poster presentation on April 23 at the AACE 19th Annual Meeting.

All too often, patients with diabetes do not see any diabetes educators or receive counseling about diet or exercise. Their primary care physician will prescribe medication, but without giving them any other advice, Dr. Sachmechi noted. “In spite of many clinical challenges by serving a largely uninsured population with generally poor health literacy at Queen’s Hospital Center, the outcome of referred patients to the Diabetes Center of Excellence in terms of weight loss and hemoglobin A1c reduction has been above the national average,” he said.

The retrospective case-control study included 150 patients with Type 2 diabetes who were referred to the diabetes center by their primary care physician. The patients saw 2 diabetes educators as well as a dietitian for advice about nutrition and diet between January 2007 and June 2008. These patients were compared with a control group of 150 patients who also had Type 2 diabetes and were treated by their primary care physician but who did not see the diabetes educators or the dietitian during this same period of time.

Dr. Sachmechi and his team compared A1c and weight before and 6 months after diabetes education and dietitian counseling in both groups.

Among patients who saw the diabetes educators and dietitian, the mean A1c was reduced by 1.02%, from 8.47% to 7.46% (P < .01). In the control group who did not see the diabetes educators or dietitian, the mean A1c was also reduced by 0.59%, from 7.8% to 7.24% (P < .01).

In addition, patients who saw the diabetes educators and dietitian had a greater reduction in mean weight (P < .05). Both groups received similar diabetes treatment from the physicians in the primary care clinic, but this study demonstrates that diabetes education and dietitian counseling can improve glycemic control and weight loss, Dr. Sachmechi concluded. “The diabetes educators provided home glucose monitoring teaching, told patients how to behave in case of hyperglycemia and hypoglycemia, and exercise. It was not expensive to provide this counseling. It certainly costs less than a session with a physician.” [Presentation title: Impact of Diabetes Education on HBA1c and Weight Reduction. Abstract 221] presented at the American Association of Clinical Endocrinologists (AACE) 19th Annual Meeting and Clinical Congress.