Chronic Effect of Dietitian-Led Nutrition Therapy of Food Order on Diabetic Complications and Intima Media Thickness in Outpatients with Type 2 Diabetes at Primary Care Clinic after 4 years : Retrospective Cohort Study

Abstract

The aim of this retrospective cohort study was to evaluate the effect of 4-year-dietitian-led medical nutrition therapy on diabetic complications and carotid intima media thickness (IMT) in outpatients with type 2 diabetes (T2DM) at a primary care clinic. Eighty-three participants were provided with dietitian-led medical nutrition therapy focusing food order “eating vegetable before carbohydrate” based on the Japan Diet (intervention group) and 78 participants were provided without dietitian-led nutrition therapy (control group). The two groups were compared for progression of diabetic complications and IMT for 4 years. After 4 years significant improvements in HbA1c (8.2 ± 1.4% to 7.6 ± 1.0%, p < 0.01), systolic blood pressure, and diastolic blood pressure were observed in the intervention group, whereas Total Cholesterol and LDL-Cholesterol were improved in the control group. The dietitian-led nutrition therapy with food order was effective to prevent diabetic complications including cerebrovascular disease, hypertension, and dyslipidemia while the ratio of atherosclerosis and cerebrovascular disease increased in the control group after 4 years. Maximum IMT decreased slightly in both groups (intervention group; 1.051 to 1.022 mm, control group; 1.019 to 0.994 mm), although the decrement was neither statistically significant between groups nor before and after the medical treatments. This result indicates that the dietitian-led nutrition therapy with food order was effective on glycemic control and suppression of diabetic complications, such as atherosclerosis, cerebrovascular disease, and hypertension, but both medical nutrition therapy and regular medical treatments are effective in suppressing the progression of IMT for 4 years in individuals with T2DM.