Cost-Effectiveness of Medical Nutrition Therapy Provided by Dietitians for Persons with Non–Insulin-Dependent Diabetes Mellitus

Franz, Marion J.; Splett, Patricia L.; Monk, Arlene; Barry, Bridgette A.; McCLAIN, Kathryn; Weaver, Tanya; Upham, Paul; Bergenstal, Richard M.; Mazze, Roger S.

doi:10.1016/s0002-8223(95)00277-4

Cited by 97 publications

(37 citation statements)

References 17 publications

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“…Researchers have long lamented the difficulties in adhering to diets for diabetes (25). The A1C reduction observed in the ADA group was similar to that found in previous studies (26). A potential weakness of the ADA guidelines is that they require portion size limits for overweight individuals, and limitations on saturated-fat intake are based on these limited energy intakes.…”

Section: Statistical Analysessupporting

confidence: 67%

A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

Barnard

Cohen²,

Jenkins³

et al. 2006

Diabetes Care

373

359

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OBJECTIVE -We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes.RESEARCH DESIGN AND METHODS -Individuals with type 2 diabetes (n ϭ 99) were randomly assigned to a low-fat vegan diet (n ϭ 49) or a diet following the American Diabetes Association (ADA) guidelines (n ϭ 50). Participants were evaluated at baseline and 22 weeks.RESULTS -Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA 1c (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P ϭ 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P ϭ 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P Ͻ 0.001). Body weight change correlated with A1C change (r ϭ 0.51, n ϭ 57, P Ͻ 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P ϭ 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24h) than in the ADA group (10.9 mg/24 h) (P ϭ 0.013).CONCLUSIONS -Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.

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Section: Statistical Analysessupporting

confidence: 67%

A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

Barnard

Cohen²,

Jenkins³

et al. 2006

Diabetes Care

373

359

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“…29 Other studies have shown the effectiveness of dietetic intervention on minimising or delaying the costs of drug and other treatment in cardiovascular disease 30 and diabetes. 31 This study did not attempt to assess cost effectiveness using health economics modelling but it is clearly evident that implementation of the FBI programme in a real-practice setting is likely to be more cost efficient than standard individual dietetic counselling, while at the same time achieving similar outcomes over a 12-month period.…”

Section: Discussionmentioning

confidence: 99%

A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months

et al. 2006

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Objective: To investigate the effect of an 8-week group-based cognitive behaviour therapy lifestyle intervention with monthly follow-up to 6 months and further follow up at 12 months on change in weight and other weight-related variables, change in physical activity and change in health and well being compared to individualised dietetic treatment or giving an information booklet only (BO). Design: A randomised controlled trial of two intervention groups, a group-based cognitive behaviour therapy lifestyle intervention, Fat Booters Incorporated -(FBI) and individualised dietetic treatment (IDT) and control group receiving an information booklet only (BO). The intervention groups involved weekly contact for 8 weeks with monthly follow-up to 6 months and further follow-up at 12 months, conducted in real practice setting. Subjects: A total of 176 adults with body mass index (BMI)427 kg/m 2 , mean (7s.d.) age 48713 years, mean BMI 3475.5 kg/m 2 . Main outcome measures: Weight, percent body fat, waist circumference, physical activity, health status, self-efficacy and satisfaction with life were measured at baseline, 3, 6 and 12 months. Results: A statistically significant difference between groups was observed for weight change over time (P ¼ 0.05). The change in weight (mean7s.e.) for the FBI group was significantly greater than the BO group at 3 and 12 months (À2.870.7 compared to À1.070.6 kg, Po0.05 and À2.970.9 compared to þ 0.570.9 kg, Po0.005, respectively). Change in weight in the IDT group did not differ from the FBI group at any time point. For all groups, waist circumference was significantly less than baseline at all time points (Po0.001). Significant differences in self-efficacy were observed over time (P ¼ 0.02), with both intervention groups having greater self-efficacy than the BO group. Significant drop-outs occurred over time for all three groups. Conclusions: A cognitive behaviour-based lifestyle intervention was more effective than providing an information booklet alone and as effective as intensive individualised dietetic intervention in weight loss and improvements in self-efficacy. International Journal of Obesity (2006) IntroductionOverweight and obesity have grown to be one of the major public health problems of the 21st century, both in developed and developing countries. 1 Recent national data indicate that approximately 60% of the adult Australian population is overweight or obese. 2 Obesity per se has now been recognised as an independent chronic condition, which contributes over 4% to the burden of disease in Australia. 3 Combined with lack of physical activity, which contributes 7%, this is an overall contribution of 11%. The true cost of this burden of disease has been estimated at A$680-1239m from the impact of obesity and overweight alone. 4 Received 25 International Journal of Obesity (2006) 30, 1557-1564 & 2006 Nature Publishing Group All rights reserved 0307-0565/06 $30.00 www.nature. com/ijoIntervention studies for the management of overweight and obesity have shown disappointing ...

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“…BC consisted of a single visit with a dietitian. Serum glucose and HbA 1 c levels fell after 6 months, in both the PGC group and the BC group (70). No l o n g -t e rm outcome data were collected.…”

Section: Economic Analysis Of Interventions For Diabetesmentioning

confidence: 99%

“…The cost-benefit ratio of each intervention was adjusted (and slightly enhanced) by subtracting medication savings accrued during the intervention program from program costs (70). The unadjusted and adjusted cost-benefit ratio figures per decline in plasma glucose and HbA 1 c levels are presented in Ta b l e 11.…”

Section: Economic Analysis Of Interventions For Diabetesmentioning

confidence: 99%

An economic analysis of interventions for diabetes.

Klonoff¹,

Schwartz²

2000

Diabetes Care

239

133

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The objective of this article is to stratify interventions for diabetes according to their economic impact. We conducted a review of the literature to select articles that performed a cost-benefit analysis for 17 widely practiced interventions for diabetes. A scale for categorizing interventions according to their economic impact was defined. The 17 interventions were classified as follows: 1) clearly cost-saving, 2) clearly cost-effective, 3) possibly cost-effective, 4) non-cost-effective, or 5) unclear. Clearly cost-saving interventions included eye care and pre-conception care. Clearly cost-effective interventions included nephropathy prevention in type 1 diabetes and improved glycemic control. Possibly cost-effective interventions included nephropathy prevention in type 2 diabetes and self-management training. Non-cost-effective interventions were not identified. Interventions with unclear economic impact included case management, medical nutrition therapy, self-monitoring of blood glucose, foot care, blood pressure control, blood lipid control, smoking cessation, exercise, weight loss, HbA1c measurement, influenza vaccination, and pneumococcus vaccination. Widely practiced interventions for patients with diabetes can be clearly cost-saving and clearly cost-effective. These practices are attractive from both a medical and an economic perspective.

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Cost-Effectiveness of Medical Nutrition Therapy Provided by Dietitians for Persons with Non–Insulin-Dependent Diabetes Mellitus

Cited by 97 publications

References 17 publications

A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months

An economic analysis of interventions for diabetes.

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