Clinical and Economic Benefits of Cardiovascular Risk Management by a Dietician in Type 2 Diabetes Patients

Worldwide, health systems and practitioners are facing obesity epidemics. High blood pressure, dyslipidemia and diabetes prevalence will explode during the 21st century.

The two main objectives of this 2-year controlled prospective study are:

1. to demonstrate that, for patients with high blood pressure, diabetes and dyslipidemia, dietician conducted survey and management in combination with annual endocrinologist follow-up enable both attainment and maintenance of recommended blood pressure, glycemic and lipid goals, as well as smoking cessation;
2. to demonstrate that dietician management is more cost effective than conventional care provided by general practitioners and endocrinologists.

Results are expected to show significantly different cardiovascular risk profiles (BMI and waist circumference, systolic and diastolic blood pressure, LDL-C, triglycerides and Total cholesterol/HDL ratio, HbA1c, smoking) between baseline and after 2 years follow-up. Sample size was determined in order to show statistically significant differences between the two groups.

Results will document for the benefit of care givers, health economists and policy makers alike an innovative and integrated model of care which is expected to be effective at the patient level as well as cost effective with respect to the increasing financial burden of diabetes on the health system.

• Type 1 Diabetes
• Type 2 Diabetes

• Behavioral: Intensive treatment
  Subjects will be followed by the dietician in combination with his/her endocrinologist. Diet, physical activity, smoking cessation and drug prescriptions will be used to treat subjects.
• Other: Normal follow-up
  Subject will continue to be followed by their endocrinologist and general practitioner as they already do.

• Experimental: Intensive treatment
  Submitted to an intensive follow-up by the dietician.
  Intervention: Behavioral: Intensive treatment
• Active Comparator: Usual treatment
  Subjects will remain under the care of their endocrinologist and/or general practitioner.
  Intervention: Other: Normal follow-up

Inclusion Criteria:

• HbA1c > 7%
• More than 2 follow-up visits