Roshani Waas, DNP, FNP-BC, RN

Abstract:

Objectives: To standardize health education about low carbohydrate diets, portion size control, and nutritional label literacy in an outpatient setting to increase patient’s knowledge and facilitate behavior change as a means to better manage Type 2 Diabetes Mellitus. Background: Type 2 diabetes mellitus (T2DM) is a growing public health concern that affects nearly 29 million and now is the seventh leading cause of death in U.S. residents; 10% of U.S. residents were T2DM-affected in 2017, as many as 33% may be affected by 2025. Standardization of nutritional education for diabetes management can improve health outcomes and achieve glycemic control. Nutritional interventions focused on calorie reduction, and minimal carbohydrate intake are recognized to be the basis of treatment. Methods: Participants (n=14) received standardized evidence-based nutrition education intervention focused on a low carbohydrate diet, portion size control, and nutrition label literacy within a primary care setting. Participants had an eight-week follow up visit with the same provider to reinforce subject matter and collect data. The primary outcome of the intervention was HgbA1c, and secondary outcomes were knowledge retention, improved BMI, and improved TTM stage of change which were measured at the baseline and eight-week follow-up visit. Patient satisfaction were also measured at eight-week follow up. Results: Of the 14 participants, nine showed lower HgbA1c at the post-intervention visit, one showed no change, and four showed a higher measurement; with mean and median measures of 7.53% (SD 0.90) and 7.2%, respectively. Changes in knowledge score between the pre and post intervention visits were positive, meaning participants either scored the same or higher of up to six points increase on their post-intervention score. Specifically, the mean of the pre- and post-intervention knowledge scores were 5.7 (SD 1.48) and 7.3 (SD 2.02), respectively, and the difference in knowledge across individuals was 1.64 (SD=1.5). No statistical significance in pre and post intervention for BMI. Overall, positive feedback was received on the patient satisfaction survey. Conclusions and Implications: Implementing a standardized, low-cost approach to include nutritional education focusing on portion size control, nutrition label literacy, and low carbohydrate in primary care may help achieve glycemic control. Focusing on preventive care may sustain potential return of investment through limited expenditures on specialty care services.

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