Evidence-Based Care Summary 1

Evidence-Based Care Summary

Hannah Bodenhamer

School of Kinesiology and Nutrition, University of Southern Mississippi

NFS 774: Management of Nutritional Services: A Behavioral Approach

Dr. Holly Huy, Ph.D., RD

March 13, 2022

Evidence-Based Care Summary 2

Evidence-Based Practice Worksheet

Intern Name

Hannah Bodenhamer

Disease State

Diabetes Mellitus (Type 2)

100-word summary of your patient’s medical diagnosis, care, prognosis, and nutrition needs. USM
students MUST submit a copy of their actual chart note and NCP form for this patient in NFS 567L.

The patient was admitted to Palm Terrace Healthcare & Rehabilitation Center via ambulance
from a local hospital. The patient’s admitting diagnosis is generalized weakness and observation
post-fall and is expected to fully recover. The patient was admitted with preexisting type 2 diabetes
mellitus (T2DM), obesity, neuropathy, and anemia. The patient is currently receiving nutrition
intervention for T2DM and is on a controlled carbohydrate (CCHO) and no-added salt (NAS) diet with
regular texture and thin liquids. The dietitian recommended a 1,850-2,125 kcal diet with 92 grams of
protein and a 1,850 cc per day. The patient reports no history of diabetes nutrition counseling and does
not practice blood sugar management strategies at home.

350-word abstract of a peer-reviewed research article on the Nutrition-Related care of this type of
disease/condition. The following must be included: reference (not included in the word count) purpose,
methods, results (including actual data & p-values, as appropriate, and conclusions. A copy of the
article also MUST be attached to the assignment in Canvas.

Marincic, P. Z., Hardin, A., Salazar, M. V., Scott, S., Fan, S. X., & Gaillard, P. R. (2017). Diabetes
Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A
Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions
through Retrospective Chart Review. Journal of the Academy of Nutrition and Dietetics,
117(8), 1254–1264. https://doi.org/10.1016/j.jand.2017.01.023

The purpose of this study is to determine the effect of diabetes self-management education
(DSME) or medical nutrition therapy (MNT) programs on health outcomes in those with type two
diabetes mellitus (T2DM). Previous research indicates that DSME and MNT with a registered dietitian
nutritionist (RDN) have improved clinical outcomes for individuals with T2DM. However, only 6.8%
of newly diagnosed T2DM patients with a private insurer attend a DSME program. Medicare Part B
covers 10 hours per year of DSME and 3 hours per year of MNT for those with new T2DM diagnoses.
In order to receive insurance compensation, DSME programs must be recognized by the American
Diabetes Association (ADA) and MNT must be provided by an RDN. Copays or lack of coverage exist
as a barrier to these intervention programs. This study will evaluate patient outcomes for those
attending DSME programs or MNT to further support insurance reimbursement and public policies to
improve patient access to these essential services. This retrospective chart review assessed a random
sample of 100 charts from an electronic medical record (EMR) for patients with T2DM completing an
Evidence-Based Care Summary 3

ADA-recognized program: MNT with an RDN or DSME. Outliers were removed for those who did not
meet the attendance criteria, resulting in a sample of 88 patients (n=88). The collected chart data
include body mass index (BMI), body weight, HbA1c, blood glucose levels, and blood lipid levels at
baseline, at the end of the program, and at one year. A mixed-model analysis of variance was applied to
assess changes in these variables throughout each program and after one year. 72% of patients reached
their target HbA1c% values (<7.0%) after their respective education programs (P<0.001) and
maintained those levels for one year (P<0.001). Significant weight reduction (-5.4 +/- 9.0 kg) was
observed after completion of the program (P<0.001). Triglyceride levels were shown to decrease
(p=0.023) and HDL levels were shown to increase following the completion of the program (p=0.007).
The key anthropometric and biochemical markers for diabetes management improved across all data
sets after the completion of MNT or DSME. This study produced evidence to further support the use of
DSME or MNT for diabetes management, indicating the necessity for supportive public policy and
insurance reimbursements.

100-word summary of the EAL, Cochrane, or ASPEN evidence summary of the nutrition-related
guidelines.

The EAL recommends that all patients with T2DM receive 3 to 6 MNT sessions within six
months of their initial diagnosis (2015). A study found that those who received MNT were able to
significantly reduce their HbA1c by up to 2.0%, optomize medication use, and improve quality of life
within six months. Patients with diabetes attend one or more annual MNT follow-up sessions resulted
in further HbA1c reductions and general maintenance of blood sugar control. There is currently no
EAL recommendation for DSME implementation, though, one study suggests DSME programs can
produce weight loss and HbA1c reductions (2014).

Summary of the strengths and limitations of the research article and the rating of the evidence provided
in the summary.

The limitations of the research article include a small sample size (n=88) and missing data for
some patients. However, the mixed model analysis of variance can account for missing data. These
limitations may result in the lack of an applicable conclusion to the broad population, leading to a call
for more research on this topic. The strengths of research include the ease in data collection,
inexpensive study design, multiple applications for clinical research, and reproducibility. Therefore, this
study may serve as a guide for individual programs or RDNs to complete an analysis on the efficacy
and success of their diabetes education services.
The evidence supporting initial MNT counseling sessions with annual follow ups is strong and
imperative. The EAL refers to studies which evaluated the efficacy of initial MNT encounters and
follow-up MNT encounters for diabetes management (2015). The EAL lists no risks or harms of
implementing these recommendations. The EAL briefly discusses the DSME program in relation to
weight loss, with findings indicating that DSME programs may also result in weight loss and HbA1c
reductions (2014).

150-200-word summary of how the research and evidence can be used in clinical practice

Current evidence supports MNT encounters or participation in DSME programs for those with
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diabetes. Regardless of diabetes classification (type 1, type 2), these interventions show positive results
in many key anthopometric and biochemical outcome measures. For best outcomes, MNT should be
administered 3 to 6 times within the first six months of diagnosis and annually thereafter (EAL, 2015).
The EAL currently has no recommendations on duration or frequency of DSME encounters, but
recognizes the program’s success in improving diabetes outcomes. DSME national standards have
different frequency requirements for different programs. For example, an accredited diabetes
prevention program (DPP) must offer 16 classes in the inital six months and one class per month in the
following six months (Marincic et. al., 2017). Improvements seen in these types of programs may
reverse if not well-maintained. Therefore, follow-up counseling or “maintainance counseling” is
imperative for one’s long-term health goals. Every patient diagnosed with diabetes should receive
counseling with a RDN or diabetes specialist help facilitate the diet and lifestyle changes necessary to
achieve optimal diabetes manamgent. The patient at Palm Terrace Healthcare & Rehabilitation Center
should be referred to an outpatient dietitian for annual diabetes MNT encounters, or to a DSME
maintenance program.
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References

Marincic, P. Z., Hardin, A., Salazar, M. V., Scott, S., Fan, S. X., & Gaillard, P. R. (2017).

Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient

Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist

Interventions through Retrospective Chart Review. Journal of the Academy of Nutrition

and Dietetics, 117(8), 1254–1264. https://doi.org/10.1016/j.jand.2017.01.023

RECOMMENDATIONS SUMMARY DM: Medical Nutrition Therapy. (2015). Evidence Analysis

Library. Retrieved March 7, 2022, from

https://www.andeal.org/template.cfm?template=guide_summary&key=4494

​SSPSM: WEIGHT LOSS. (2014). Evidence Analysis Library. Retrieved March 7, 2022, from

https://www.andeal.org/worksheet.cfm?worksheet_id=258114