Diabetes DPG Public Library

Nutri is a health information technology enabled behavioral nutrition intervention originating in 2023 from the University of Texas at Austin which is intended to be used during routine care. Nutri processes patient-generated diet recall data and integrates into the clinical workflow to enable primary care providers (PCPs) and patients to collaboratively set a single, high impact achievable diet goal in a little as 2-3 minutes. At the provider level Nutri is based on the 5As of patient counseling: assess, advise, agree, assist, and arrange. Nutri addresses all of these aspects of care. At the patient level Nutri is based on the Integrated Behavior Model.

Nutri has been developed to address the need for provider led diabetes education/instruction given the lack of RDN presence in safety-net primary care. Diabetes education is increasingly falling on overworked and overwhelmed primary care providers and the authors maintain the point that adopting a healing diet leads to positive outcomes for patients with type 2 diabetes regardless of disease severity or medication regimen. Few receive diet education/instruction leaving a missed opportunity at each primary care visit.

This study is a cluster-randomized controlled trial in a large network of federally qualified health centers involving sixteen primary care providers, (Nutri = 8), (control = 8) and 30 of their adult diabetes/pre-diabetes patients (Nutri = 17), (control = 13). After patients completed the automated self-administered 24 hour dietary assessment tool, Nutri synthesized diet data to prioritize dietary problems and guide providers through collaborative diet goal setting during a regularly scheduled appointment. Control providers provided usual care. For the benefit of the reader, the article presents an example of Nutri’s 3 step interface for collaborative goal setting including diet recall results (screen 1, data review), shared decision making (screen 2, nutrition goal and confidence review), and review (screen 3 summary).

The authors hypothesis is that Nutri will improve providers ability to provide brief, evidenced-based diet counseling during primary care, will improve patients’ behavioral intention, self efficacy, dietary behavior and chronic disease outcomes. HbA1c values were intended to be followed and noted however one third to one half of patient has no lab

values in the medical record within the study period. On the basis of follow up testing and 100% Nutri use, provider reported counseling attitudes, self-efficacy and competency moved in the hypothesized direction. Eighty one percent of patients used the Nutri process to completion and reported goal setting, fifty seven percent initiated their goal.

The authors speculate in these areas for possible study bias:

1. Participating providers may have been inherently interested in talking about diet with patients than those providers that declined to participate
2. Despite stratified study randomization there was a large difference in age between the treatment and control groups
3. A single 24 hour diet recall precludes the estimation of usual intakes.