A Practical Guide to Delivering Nutritional Advice to People with Diabetes
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PRACTICAL APPROACH
A Practical Guide to Delivering Nutritional Advice to People with Diabetes Pamela A. Dyson
Received: November 14, 2018 Ó The Author(s) 2019
ABSTRACT Dietary advice is fundamental to the management of diabetes. Although ideally such advice should be delivered by a state-registered dietitian, it is more usually delivered by other health professionals. The primary focus for those with type 1 diabetes is carbohydrate counting and insulin adjustment and for the majority of people with type 2 diabetes, weight management is key. Patient-centred care is emphasised for the delivery of dietary advice. It is widely recognised that knowledge alone is not sufficient to induce behaviour change and practical approaches to a variety of behavioural interventions are discussed.
Keywords: Diabetes; Diet; Person-centred Abbreviations ADA American Diabetes Association CBT Cognitive behavioural therapy DiRECT Diabetes remission clinical trial HbA1c Glycated haemoglobin Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.7454978. P. A. Dyson (&) Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK e-mail: [email protected]
MI PCC SFT SMART SMBG TDR
Motivational interviewing Patient-centred care Solution-focused therapy Specific, measurable, achievable, realistic and time-based Self-monitoring of blood glucose Total diet replacement
INTRODUCTION There is a wealth of evidence demonstrating that dietary interventions are effective for the management of both type 1 and type 2 diabetes, for the prevention of type 2 diabetes, and there is now emerging evidence for the remission of type 2 diabetes [1–5]. Traditionally, it is recommended that nutritional advice is delivered by registered dietitians, and although there is evidence that dietitian-led interventions are more effective than those without input from dietitians [6], both the American Diabetes Association (ADA) and Diabetes UK recognise that other health professionals have a role in delivering dietary advice, ideally guided by a registered dietitian [1, 2]. However, access to registered dietitians is limited, and a survey in the UK in 2002 reported that the level of dietetic support for those with diabetes was dramatically lower than recommendations, and had not increased since a survey conducted 5 years previously [7].
Diabetes Ther
The current recommended gold standard of care is to deliver dietary advice as part of intensive multicomponent lifestyle programmes, and this is endorsed by both international and national bodies [8–11]. However, in the UK for example, despite the fact that structured education was offered to 50% of those with type 1 diabetes and 90% of those with type 2 diabetes in 2015–2016, only 5–10% attended education programmes [12]. In many areas of the world, there are no dietitians or education programmes available, and where there are, limited uptake and restricted access to these facilities mean that people with diabete
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