Date of Award

January 2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Shawnda Schroeder

Abstract

The COVID-19 global pandemic was the impetus of the transition from in-person medical nutrition therapy (MNT) visits to telephone MNT. This occurred without evaluation of its clinical effectiveness, especially for American Indians and Alaska Natives (AI/AN). It is known that in-person MNT is clinically effective at lowering hemoglobin A1c (A1c) and that people with diabetes who experience food insecurity have poorer health. However, research characterizing food insecurity among AI/ANs is limited. This retrospective observational analytical study was conducted at the Phoenix Indian Medical Center (PIMC) in Phoenix, Arizona to assess the clinical effectiveness of telephone delivered MNT services by a registered dietitian nutritionist (RDN). The study also assessed the frequency of food insecurity screening. The sample included those who were non-pregnant AI/AN adults and who were newly diagnosed with Type 2 diabetes (T2DM) between 2022 and 2023 at the PIMC. A total of 166 individuals met the inclusion criteria; 30% received telephone MNT and 70% did not engage in any MNT. When comparing the participants who received telephone MNT to those who did not, there were no significant differences in participant age, gender, primary care provider (PCP), pre- and post-A1c test results, or medications prescribed. However, regression analysis demonstrated a significant relationship between participants who received medical nutrition therapy via telephone and improved A1c levels (p <0.05). Results also revealed that only 20% of MNT recipients were screened for food insecurity. Medical nutrition therapy can be successfully delivered over the telephone to reduce or manage the A1c levels of AI/AN adults with Type 2 diabetes. However, there is still significant work that must be done to ensure all individuals are screened for food insecurity. The results of this research offer important clinical practice implications for registered dietitian nutritionists practicing with Indian Health Service, Tribal and Urban Indian Health Organizations.

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