In order to establish the clinical evidence necessary as a base for nutrition instructions, methods and educational programs that can guarantee an advantageous effect are necessary, independent of the registered dietitian.s individual experience, the medical institution and the area. Accordingly, we devised an original “Educational instructions guideline for diabetes patients for practitioners" (hereafter, the E-guideline). The E-guideline was used by registered dietitians (years-of-experience 9 . 5±13 . 8) in 6 medical institutions, in order to evaluate its validity. The subjects were 18 patients with type 2 diabetes without insulin treatment(11 men and 7 women) who did not show any overt chronic complications, such as diabetic neuropathy, nephropathy, or retinopathy. Nutrition instructions were carried out by nine registered dietitians. All of the instructions were based on the E-guideline and conducted until each patient achieved an HbA1c( NGSP) value under 6.8%. A maximum of 6 instructions were employed, and discontinued when the subject achieved the target HbA1c value. After the last instruction, we carried out the questionnaire survey to evaluate the E-guideline for both patients and registered dietitians. Both HbA1c and body mass index were significantly improved in 88.3% of the subjects (p<0 . 001 and p<0 . 01, respectively). However, the registered dietitian's number of years of experience and the HbA1c improvement rate were not correlated significantly. These results suggest that the E-guideline can contribute to the establishment of the necessary clinical evidence because it does not depend on differences between medical institutions or the registered dietitian's number of years of experience. The questionnaire surveys revealed that 84 . 6% of the subjects and most of the registered dietitians approved of the guideline. In conclusion, we would like to emphasize that our E-guideline is the first practical and useful tool for all registered dietitians, both with or without experience in providing nutrition instructions.

View full abstract