LEARNING OUTCOME: This practice-based research entails an assessment of efficacy of MNT, implementation of a MNT protocol and development of a critical pathway for outpatients with NIDDM.

A retrospective record review was conducted for 21 out of 74 (28%) outpatients attending the diabetes nutrition class between August and October 1993. Thirteen (62%) were referred to the dietitian within one month of diagnosis. Six (38%) received follow up within two weeks and only one at one year after initial education. Labs were insufficient to evaluate glycemic control following nutrition intervention and only one individual requiring oral agents or insulin experienced reduction in medication doseage.

A follow-up protocol was implemented October 1995. The protocol consists of an initial group class and individual follow-up at 2, 4, 6,12, and 24 weeks later. A credentialled dietitian ordered fasting blood glucose, Hgb A1C, and lipid profiles at baseline, 6,12, and 24 weeks. A critical pathway for NIDDM patients was formed by an 18-mem her multidisciplinary team facilitated by a dietitian to improve patient care. One month data collection revealed that the rate of nutrition follow-up had improved with 6 out of 12 patients returning for at least 1 follow-up visit. Three months of data collected for 9 patients (avg 3.5 visits) revealed 3 of 4 at the 6 week point with an average 25% decrease in Hgb A1C and 3 of 5 at the 3 month point reaching target values (≤ 7.5%). All eight individuals requiring diabetes medications experienced reduced doseage. Thus, nutrition intervention appeared to improve clinical outcomes for diabetics with barriers such as lack of data and poor follow-up habits. Future plans include collecting data to evaluate the critical path, marketing nutrition follow-up, and computerizing medical records.