Propuesta de abordaje nutricional y dietoterapeútico basado en evidencia para el manejo integral de un paciente con diabetes mellitus tipo 2 descompensada y artritis reumatoide: análisis retrospectivo de un caso clínico.

Abstract

Type 2 diabetes mellitus is one of the most prevalent chronic noncommunicable diseases worldwide and remains a major challenge for healthcare systems because of its high prevalence, associated complications, and need for comprehensive management. When it coexists with chronic inflammatory conditions such as rheumatoid arthritis, nutritional management becomes more complex, highlighting the need for individualized interventions supported by scientific evidence. This study aimed to design a nutritional and dietetic care proposal for an adult patient with poorly controlled type 2 diabetes mellitus, overweight, and rheumatoid arthritis. The proposal was based on the best available scientific evidence and focused on improving metabolic control and nutritional status while promoting adherence to treatment. A retrospective clinical case study was conducted using secondary information from the clinical, anthropometric, biochemical, and dietary data available in the case. No direct intervention or additional patient assessment was performed. The proposal followed the Nutrition Care Process and integrated anthropometric, biochemical, clinical, and dietary assessment, together with the formulation of nutrition diagnoses using the PES format. A narrative search of recent scientific literature was also conducted using biomedical databases and international clinical practice guidelines. The dietetic proposal was developed according to the nutritional needs identified in the patient. Nutritional requirements and macronutrient distribution were established based on current evidence, and a Mediterranean dietary pattern adapted to the Ecuadorian context was proposed. The approach also included nutrition and diabetes education, nutritional follow-up, and participation of a multidisciplinary team. The assessment identified a lack of food- and nutrition-related knowledge as the main nutrition problem, which may negatively affect both glycemic control and the overall quality of the patient's diet.