Impact of Diabetes Prevention Guideline Adoption on Health Outcomes: A Pragmatic Implementation Trial
Impact of Diabetes Prevention Guideline Adoption on Health Outcomes: A Pragmatic Implementation Trial
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DOI：
10.1016/j.jand.2020.11.001
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发表时间：
2021-09-20
影响因子：
4.8
通讯作者：
Papoutsakis, Constantina
中科院分区：
文献类型：
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作者：
Murphy, William J.;Hand, Rosa K.;Papoutsakis, Constantina
评估营养指南对临床实践和患者健康结果的影响的研究有限。在这项研究中，我们调查(1)指南培训对糖尿病预防循证营养实践指南(EBNPG)实施的影响，以及(2)EBNPG一致性与糖尿病前期患者健康结局的关系。我们进行了一项实施研究，其中注册营养师(RDN)在实施糖尿病预防EBNPG的专业培训前后对102名糖尿病前期患者进行了为期3个月的营养护理。使用RDNS的营养护理流程(NCP)文件，我们测量了指南一致性百分比和健康结果(体重、腰围、空腹血糖、糖化血红蛋白)，并模拟了健康结果。训练后指标一致性提高4.3%(P<；0.05)。然而，没有观察到指南培训或指南一致性与健康结果之间的显著关联。在整个研究过程中，我们的模型显示出腰围(2.1+/-0.92厘米；P=0.023)和体重(-1.78+/-0.55公斤；P=0.001)的减少。对营养专业人员的培训提高了对预防糖尿病的EBNPG的一致性。然而，指南一致性的改善并不影响相关的健康结果。包括营养干预在内的标准护理导致体重和腰围减少。未来的研究需要进一步解决循证指导方针对所有实践领域成果的影响。
Limited research exists to evaluate nutrition guideline impact on clinical practice and patient health outcomes. In this study we investigate (1) the impact of guideline training on the implementation of the diabetes prevention Evidence-Based Nutrition Practice Guideline (EBNPG), and (2) the relationship between EBNPG congruence and resulting health outcomes in patients with prediabetes. We conducted an implementation study in which registered dietitian nutritionists (RDNs) provided nutrition care with 3-month follow-up to 102 pre-diabetes patients before and after a professional training on the implementation of the Diabetes Prevention EBNPG. Using the RDNs' Nutrition Care Process (NCP) documentation, we measured percent guideline congruence and health outcomes (body weight, waist circumference, fasting glucose, glycosylated hemoglobin), and modeled health outcomes. Guideline congruence improved after training by 4.3% (P < 0.05). However, no significant associations were observed between guideline training, or guideline congruence and health outcomes. Our model showed a reduction in waist circumference (2.1 +/- 0.92 cm; P = 0.023), and body weight (-1.78 +/- 0.55 kg; P = 0.001) throughout the course of the study. Training of nutrition professionals improved congruence to EBNPG for Diabetes Prevention. Nevertheless, improved guideline congruence did not impact related health outcomes. Standard care including nutrition intervention resulted in body weight and waist circumference reductions. Future research needs to further address the impact of evidence-based guidelines on outcomes in all areas of practice.