(P23-025-23) The Effectiveness of Dietitian-Provided Medical Nutrition Therapy in Adults With Prediabetes: A Systematic Review and Meta-Analysis

Objectives: The objective of this systematic review was to examine the effectiveness of medical nutrition therapy (MNT) provided by a registered dietitian or international equivalent (dietitian), compared to usual care or no intervention, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes.

Methods: Searches were conducted for eligible randomized controlled trials (RCTs) published between 1986 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. Meta-analysis was conducted using a random-effects model for glycemic biomarkers, cardiometabolic risk factors, and anthropometric outcomes.

Results: Thirteen RCTs (n=2308) were included in the analysis and employed a variety of dietary interventions delivered by dietitians. Intervention duration ranged from 3 to 24 months. Compared to usual care, MNT provided by a dietitian resulted in improved hemoglobin A1c (HbA1c) [mean difference (95% CI):  -0.30% (-0.49, -0.13)]; fasting blood glucose (FBG) [-4.97 mg/dl (-6.24, -3.71)]; weight [-3.23 kg (-3.98, -2.50)]; BMI [-1.49 kg/m² (-2.17, -0.82)]; waist circumference (WC) [-0.14 cm (-0.27, -0.02)]; total cholesterol (TC) [-0.11 mmol/L (-0.19, -0.04)]; high-density lipoprotein (HDL-C) [0.10 mmol/L (0.02, 0.18)]; low-density lipoprotein (LDL-C) [-0.14 mmol/L (-0.27, -0.02)]; systolic blood pressure (SBP) [-2.91 mmHg (-4.59, -1.24)]; and diastolic blood pressure (DBP) [-2.33 mmHg (-3.45, -1.24). Triglycerides (TG) were unchanged [-5.98 mg/dl (-12.55, 0.78)]. Two studies reported a reduced instance of developing type 2 diabetes mellitus (T2DM). Certainty of evidence was moderate for FBG, weight, WC, TC, TG, SBP, and DBP and low for HbA1c, BMI, HDL-C, LDL-C, and incidence of T2DM.

Conclusions: In adults with prediabetes, MNT provided by a dietitian is effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. Dietitians play a key role in improving cardiometabolic risk factors in adults with prediabetes. Future research should explore the role of dietitians in improving health outcomes for individuals with prediabetes.

Funding Sources: This research was funded by the Academy of Nutrition and Dietetics Foundation’s Evidence Analysis Library Academy Foundation Research Endowment.