title: Prospective randomized controlled trial to evaluate effectiveness of registered dietitian-led diabetes management on glycemic and diet control in a primary care setting in Taiwan.
abstract: OBJECTIVE
  In this randomized controlled trial we evaluated the effect of registered dietitian-led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures.
  
  
  METHODS
  We recruited 154 adult patients with type 2 diabetes and randomly assigned them to a routine care control group (n = 79) or a registered dietitian-led intervention group (n = 75) who received on-site diabetic self-management education every 3 months over 12 months.
  
  
  RESULTS
  Over the 1-year period, neither the intervention group (n = 75) nor the control group (n = 79) had significant changes in A1C, whereas the intervention patients with poorly controlled baseline A1C (> or =7%) (n = 56) had significantly greater improvements in A1C and fasting plasma glucose than the control subjects (n = 60) (-0.7 vs. -0.2%, P = 0.034; -13.4 vs. 16.9 mg/dl, P = 0.007) during the same period. We also found significant net intervention-control group differences in overall energy intake (-229.06 +/- 309.16 vs. 56.10 +/- 309.41 kcal/day) and carbohydrate intake (-31.24 +/- 61.53 vs. 7.15 +/- 54.09 g/day) (P < 0.001) in patients with poorly controlled A1C. Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and A1C in the intervention group (n = 56; beta = 0.10, SEM = 0.033, P = 0.004).
  
  
  CONCLUSIONS
  On-site registered dietitian-led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan. A reduction in carbohydrate intake may improve glycemic status.
authors.affiliation: Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Meng-Chuan
authors.initials: MC
authors.lastname: Huang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Huan-Sen
authors.initials: HS
authors.lastname: Wang
authors.forename: Shyi-Jang
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D048909:Diabetes Complications / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood* / Q000178:diet therapy* / Q000503:physiopathology; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates; D004522:Educational Status; D002149:Energy Intake; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018579:Patient Selection; D013624:Taiwan
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin