Comparison of the effects of frequent versus conventional nutritional interventions in patients with type 2 diabetes mellitus: A randomized, controlled trial

• Published in: Journal of diabetes investigation 2022-02, Vol.13 (2), p.271-279
• Main Authors: Kawabata, Nao, Okada, Kenta, Ando, Akihiko, Kurashina, Tomoyuki, Takahashi, Manabu, Wakabayashi, Tetsuji, Nagata, Daisuke, Kusano, Eiji, Mogi, Satsuki, Sato, Toshiko, Ishikawa, Shizukiyo, Ishibashi, Shun
• Format: Article
• Language: English
• Subjects: Albuminuria - complications; Arteriosclerosis; Blood pressure; Body composition; Body fat; Body mass index; Cholesterol; Clinical Trial; Consent; Creatinine; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - therapy; Diabetic Nephropathies - complications; Diabetic Nephropathies - prevention & control; Diabetic retinopathy; Dietitians; Education; Enrollments; Family physicians; Glomerular Filtration Rate; Glycated Hemoglobin - analysis; Hemoglobin; Hemoglobin A1c; Hospitals; Humans; Insulin; Intervention; Kidney diseases; Medical referrals; Nephrology; Nutritional education; Patients; Physicians; Proteins; Risk factors; Salt; Urine
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.13657

Aims/Introduction This randomized controlled trial aimed to determine whether frequent nutritional education improves the clinical parameters associated with the onset and progression of diabetic kidney disease in type 2 diabetes mellitus patients. Materials and Methods A total of 96 patients with type 2 diabetes and diabetic kidney disease were randomly assigned to the intensive intervention group that received nutritional education at every outpatient visit, and the usual intervention group that received nutritional education once a year. The anthropometric parameters, blood pressure, blood chemistry, albuminuria, protein and salt intake, and prescribed medications of 87 patients who completed the 2‐year follow up were analyzed. Results In the intensive intervention group, body mass index and salt intake significantly decreased over the study period. Hemoglobin A1c levels and body fat percentage were significantly lower in the intensive intervention group than in the usual intervention group. At the end of the 2‐year intervention period, the intensive intervention group had significantly lower salt intake (8.1 vs 9.4 g/day) than the usual intervention group. A significant positive correlation was found between salt intake and albuminuria in the overall group and intensive intervention group (r = 0.26, P = 0.02, and r = 0.36, P = 0.02, respectively). The intensive intervention group had a significantly lower insulin use rate than the usual intervention group after the 2‐year intervention period (18% vs 42%). No differences were found in estimated glomerular filtration rate and albuminuria. Conclusion Intensive nutritional education is useful for alleviating the risk factors associated with the onset and progression of diabetic kidney disease. Frequent nutritional education were effective in decreasing body mass index, salt intake, hemoglobin A1c and body fat percentage. Salt intake was significantly associated with albuminuria.