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