Dietistkontakt: ett vinnande koncept för förbättrad metabol kontroll hos patienter med Diabetes Mellitus typ 2 – En systematisk översiktsartikel
Sammanfattning: Title: Meeting with a dietitian: a successful concept to improve metabolic control inpatients with type 2 Diabetes Mellitus – A systematic reviewAuthors: Johanna Hultberg och Isabelle LarssonSupervisor: Frode SlindeExaminer: Anna WinkvistEducation: Programme in dietetics, 180/240 ECTSType of paper: Bachelor’s thesis in clinical nutrition, 15 higher education creditsDate: 2018-03-27Background: Diabetes can be considered the pandemic of the 21st century and its spread isrelated to economic progress and lifestyle changes around the globe. The prevalence reaches8.8 % of the adult population and is predicted to increase even further. Since diabetes is achronic disease that demands treatment through all stages of life healthcare systems shouldoffer medication and customized education to patients and their relatives to increaseknowledge and self control. The diagnose Diabetes Mellitus is split into two types that arebased on different metabolic problems that in the end causes hyperglycemia caused by lack ofinsulin production in pancreas or lack of insulin tolerance in the body’s cells. Theautoimmune type of diabetes is called type 1 (T1DM) and makes the patient dependent toinject insulin since the body no longer can create any or enough on its own. The majority ofpatients diagnosed with diabetes however has type 2 (T2DM), which is a long-spun form ofinsulin resistance usually caused by poor lifestyle.Objective: To examine the current scientific evidence of the effects on glycemic control bydietitian led lifestyle changes in adult patients with T2DM compared to standard care.Search strategy: A systematic literature search was conducted in Pubmed and Scopus. Thefollowing terms was used in different combinations: “dietitian”, “diabetes type 2”, “bloodglucose”, ”BMI”, “weight”, “weight loss” and“randomized control'“.Selection criteria: RCT studies conducted on adult (>19 years) T2DM patients measuring theeffects of HbA1c and BMI based on dietitian led lifestyle intervention has been included.Studies where the interventions included energy restriction has been excluded.Data collection and analysis: After searches in databases articles were selected andthoroughly reviewed according to the Swedish Agency For Health Technology AssessmentAnd Assessment Of Social Services (SBU) randomized control study review template. Lastlyfive articles were accepted and graded based on the Grading of RecommendationsAssessment, Development and Evaluation (GRADE) system.Main results: The results are based on four randomized controlled studies with a total of 634participants. All studies reviewed showed unanimously results related to reduced HbA1ccompared to standard care. Most studies found statistically significant results (p<0,05) inadvantage to patients included in the intervention groups compared to standard care regardingHbA1c. There was not statistically significant results regarding BMI due to both interventionand control groups lost weight which indicates that the standard care is good.Conclusion: The scientific evidence that dietitian led lifestyle intervention leads to improvedglycemic control in adult T2DM patients is high (++++). There is moderately strongscientific evidence (+++) that nutrition treatment given by a registered dietitian with the goalto improve the metabolic control lacks significant differences in BMI in patients with T2DM.This applies when there is no energy restriction required.Keywords: Diabetes type 2, dietitian, nutrition therapy, HbA1c, BMI, blood glucose control.
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