Culinary Medicine and Medical Nutrition Therapy Interventions to Improve Glycemic Control in Type 2 Diabetes: A Pragmatic Trial During the COVID-19 Pandemic

Abstract

To conduct a pragmatic, randomized controlled trial (RCT) of the effectiveness of six registered dietitian–led medical nutrition therapy (MNT) sessions compared with six virtual, hands-on culinary medicine (CM) sessions for improving glycemic control among patients with uncontrolled diabetes in a safety-net health care system. Adults (aged ≥18 years) with type 2 diabetes and hemoglobin A1c (HbA1c) ≥7.0% were eligible. We assessed within- and between-group changes in HbA1c and the Mediterranean diet score (MEDI-LITE) using difference-in-differences analyses adjusted for the number of sessions completed. The study randomized 79 participants to either CM classes (n = 36) or health system MNT visits (n = 43). Baseline characteristics were similar between groups. Participants with complete data at baseline and 6 months were included in HbA1c (n = 47; 30 MNT and 17 CM) and MEDI-LITE (n = 79; 43 MNT and 36 CM) analyses. HbA1c change over 6 months was −1.15% (P = 0.01) in the MNT group and −0.55% (P = 0.34) in the CM group. There was no difference in HbA1c change between groups (P = 0.41). No significant within-group (CM 0.75, P = 0.08; MNT 0.11, P = 0.78) or between-group (P = 0.28) differences in the MEDI-LITE score were observed at 6 months. Despite the impact of COVID-19, participants in the diverse-format MNT intervention had clinically meaningful improvements in HbA1c at 6 months. Unmet recruitment and retention goals contributed to underpowered results. Additional RCTs evaluating the impact of CM on glycemic control and dietary measures are needed.