title: Effects of clinical nutrition education and educator discipline on glycemic control outcomes in the Indian health service.
abstract: OBJECTIVE
  We used the Indian Health Service (IHS) Diabetes Care and Outcomes Audit to assess the effectiveness of clinical nutrition education in reducing HbA(1c) levels and to test the relative effectiveness of clinical nutrition education when it was delivered by a registered dietitian (RD) compared with an educator from another discipline (non-RD).
  
  
  METHODS
  We examined clinical care data collected by the IHS Diabetes Care and Outcomes Audit of 7490 medical records during 2001. Glycemic control was assessed by using the difference between the two most recent HbA(1c) levels during 2001. Age, BMI, duration of diabetes, type of treatment, proteinuria, and facility were included as covariates. Clinical nutrition education was defined as documentation in the record of any diet instruction and educator discipline classified as RD or non-RD. ANCOVA methods were used to assess the effects of diet education and educator discipline on differences between the two HbA(1c) measurements and to adjust for differences in the distribution of covariates among the education groups.
  
  
  RESULTS
  After adjustment for age, sex, type of treatment, duration of diabetes, BMI, initial HbA(1c) level, and clinical facility, clinical nutrition education and educator discipline were each associated with changes in HbA(1c) levels (P < 0.001). Those receiving clinical nutrition education from an RD or from an RD as well as a non-RD had the largest improvements in HbA(1c) levels (-0.26 and -0.32, respectively) compared with those receiving either only non-RD or no clinical nutrition education (-0.19 and -0.10, respectively).
  
  
  CONCLUSIONS
  Clinical nutrition education in the IHS is associated with favorable trends in glycemic control. To be effective, clinical nutrition education should be delivered by an RD or a team that includes an RD.
authors.affiliation: Indian Health Service, Phoenix Indian Medical Center, Phoenix, Arizona 85016, USA. wilson@pimc.ihs.gov
authors.forename: Charlton
authors.initials: C
authors.lastname: Wilson
authors.forename: Tammy
authors.initials: T
authors.lastname: Brown
authors.forename: Kelly
authors.initials: K
authors.lastname: Acton
authors.forename: Susan
authors.initials: S
authors.lastname: Gilliland
mesh_terms: D000328:Adult; D017668:Age of Onset; D001130:Arizona; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000534:rehabilitation; D004035:Diet Therapy; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D009516:New Mexico; D010353:Patient Education as Topic; D016896:Treatment Outcome; D014481:United States; D016549:United States Indian Health Service
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin