Effect of Nutrition Education on Outcomes After Initiation of Glucagon-like Peptide-1 in Adults with Diabetes

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that effects between 589 – 787 million people worldwide. It is characterized by insulin resistance, impaired pancreatic function, and dysregulated glucose metabolism. In recent decades Glucagon-like Peptide 1 receptor agonists (GLP-1RAs) have emerged as dominant anti-diabetic drugs due to their tremendous success in improving glycemic control and weight loss. Despite these advances in pharmacotherapy, the prevalence of T2DM and its related mortality rates continue to increase significantly. Nutrition Education has been shown to lower HbA1c and improve other diabetes markers both in randomized controlled trials (RCTs) and community interventions, However, very little research has been conducted on its impact as an adjunct therapy to GLP-1RAs in patients with T2DM. The aim of this study was to examine the effect of nutrition education on diabetes-related metrics among patients with T2DM who were prescribed GLP-1RAs and receiving care in the Grady Diabetes Center at Grady Memorial Hospital in Atlanta, Georgia. Methods: This study utilized a retrospective, observational design. Existing electronic health record (EHR) data was reviewed to collect outcome data in adult patients receiving GLP-1RA therapy alone, and those receiving GLP-1RA therapy in conjunction with structured nutrition education. The study population consisted of a convenience sample of 30 adult patients with T2DM treated with GLP-1RAs (15 who received nutrition education and 15 who did not). Data extracted from the EHR included demographic characteristics, anthropometric measures, glycemic control as measured by HbA1c, medication adherence, gastrointestinal symptoms, and dietary intake. Statistical analyses were conducted using SPSS version 27.0 (IBM, Chicago, IL). Results: Most of the population in both groups were Black and Non-Hispanic. Most participants in the nutrition education group were female (73.3%), whereas the no nutrition education group was split evenly between males (46.7%) and females (53.3%). There were no significant differences of height, weight or BMI between the groups. There were also no significant differences in pre- and post-therapy weights within each group. There was a significant difference between the median initial HbA1c between the education and no education groups (9.9 [Interquartile range (IQR) 8.3, 11.6] vs. 7.6 [IQR 7.0, 9.2], respectively; p=0.016). While there was no significant difference between the final HbA1c values between the groups were was a significant reduction within the education group of 2.8% after 6 months of GLP-1RA therapy (p=0.001). This improvement was not found in the no education group. While not statistically significant, a possible clinically significant reduction in weight of 2.1% was found in the education group vs. a 1.4% loss in the no education group. Conclusions: Patients receiving nutrition education simultaneously with GLP-1RA therapy may experience greater improvements in their glycemic control compared to patients who do not receive nutrition education. Future research should include a larger and more racially and ethnically diverse population to improve the accuracy and generalizability of findings. Implementing a randomized controlled trial design would further clarify the true impact of nutrition education on diabetes-related outcomes, anthropometric measures, and dietary behaviors in this population.