Nutrition & Dietetic Service to Patients with Diabetes in West Berkshire

Carolyn Jones

Dietetic Team Lead

How Effective is the Dietitian in the Management of Diabetes?

• Evidence suggests that dietary advice provided by a registered dietitian is clinically effective. (Green,2002)

HbA1c of 1% newly diagnosed Type 1 2% newly diagnosed Type 2

1% in Type 2 diagnosed 4yr

• Dietitians are uniquely skilled and there is strong evidence that dietary advice provided by registered Dietitians is an effective and essential therapy in the management of diabetes. (Franz, 2010)

Ref: Green et al (2002) The evidence for the effectiveness of Medical Nutrition Therapy in Diabetes

Therapy. Diabetes Care; vol 25, No 3, 608-611 Franz et al (2010) The Evidence for Type 1 and Type 2 Diabetes in Adults. J Am Diet Assoc;

110: 1852-1889

West Berkshire Community DietitiansReferral Criteria for Primary Care

•People with newly diagnosed Type 1 Diabetes•People with a new diagnosis of Type II Diabetes who do not want to go the Multidisciplinary Group Education sessions (X-pert) or are not suitable•People who have attended the Multidisciplinary Group (X-pert) but still have questions•People with poorly controlled type I and II Diabetes •People with Type I and II Diabetes who have not succeeded in losing weight •Diabetes with dyslipidaemia and additional risk factors (e.g. hypertension) •People with Type II diabetes recently transferred onto insulin

Education/ Training

•Deliver X-pert in partnership with DSN

•Deliver dietetic component of study days organised by DNS

e.g. Warwick Course

•Inpatient ward staff training – WBCH, WCH etc

What the Community Dietetic Service offers the patient:

• A choice of clinic venues to enable patients to be seen closer to home• A service in which the patient satisfaction is high• Dietitians that are trained in behaviour change management• Dietitians that have skills and knowledge in the management of diabetes

Case Studies – Patient 1

• Attended X-pert in Jan 14 as diagnosed with T2 DM in Nov 13. Put on 500mg metformin bd

FBG: 21.1 mmol/l HbA1c: 99mmol/mol

• During X-pert, Dietitian was aware that patient very symptomatic. She advised

him to see his GP. A visit to Westcall showed:

FBG: 39.8 mmol/l HbA1c: >160mmol/mol

• Patient was advised to double metformin and to make an appt to see GP in a

few weeks.• Patient asked dietitian to explain the results. Due to these high figures, she

contacted the GP who then liaised with Diabetes Centre at RBH. • Patient is now on insulin.

Case Study – Patient 2

• Patient seen at WHC for weight management advice. Type 2 diabetes on medication: Metformin: 1000mg bd, Gliclazide: 160mg bd , Pioglitazone 45mg od. Initial body weight: 93.6kg BMI > 30

• 2nd appointment in March, patient’s weight:

Weight: 90.2kg Wt loss: 3.4kg %Wt loss: 3.6%

Waking up with blood glucose levels between 2.5-3.5mmol/L.

Treatment included sitting down and moving hands and feet!

Recent HbA1C: 70mmol/l

• Dietitian advised on treatment of hypo’s, she liaised with the Diabetes Nurse who recommended reduction or discontinuing gliclazide

• Dietitian contacted the GP who agreed to half the gliclazide

In the future Community Dietetic Service could…

• In partnership with DSNs to;

- provide structured type 1 patient education in the community

- continue to provide structured type 2 patient education in the community

• Offer specialised diabetes clinics in conjunction with MDT

• Offer community based patient IGT and GDM group sessions

• Training of GP’s and Practice Nurses to meet QoF requirements

• Diabetes Prevention/Screening programmes