A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes.
OBJECTIVE
To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA(1c) levels in urban African Americans with type 2 diabetes.


METHODS
A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires.


RESULTS
At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA(1c) (9.4%). Improvements in glycemic control over 6 months were significant (P < 0.0001) but similar in both groups: HbA(1c) decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches.


CONCLUSIONS
Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.
Ziemer
David C
DC
Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia 30303, USA. dziemer@emory.edu
Berkowitz
Kathy J
KJ
Panayioto
Rita M
RM
El-Kebbi
Imad M
IM
Musey
Victoria C
VC
Anderson
Lynda A
LA
Wanko
Nancy S
NS
Fowke
Margaret L
ML
Brazier
Carol W
CW
Dunbar
Virginia G
VG
Slocum
Wrenn
W
Bacha
Gael M
GM
Gallina
Daniel L
DL
Cook
Curtiss B
CB
Phillips
Lawrence S
LS
D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D001835:Body Weight; D002755:Choice Behavior; D003920:Diabetes Mellitus / Q000178:diet therapy* / Q000534:rehabilitation*; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000534:rehabilitation*; D003927:Diet, Diabetic; D005247:Feeding Behavior; D005260:Female; D005845:Georgia; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010353:Patient Education as Topic / Q000379:methods*; D016896:Treatment Outcome; D014505:Urban Population
D015415:Biomarkers; D006442:Glycated Hemoglobin