Survey of dietetic provision for patients with diabetes.

AIMS

To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes.

METHODS

A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded.

RESULTS

Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100,000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100,000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100,000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100,000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100,000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosed adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes.

CONCLUSIONS

Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.