Nelson M, Lean M E, Connor H, Thomas B J, Lord K, Hartland B, Waldron S, McGough N, Walker L, Ryan A, Start K
Department of Nutrition and Dietetics, King's College London, UK.
Diabet Med. 2000 Aug;17(8):565-71. doi: 10.1046/j.1464-5491.2000.00337.x.
To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes.
A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded.
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.
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.
就糖尿病患者的相关服务情况，对参与糖尿病护理工作的营养师展开调查。
1997年对512名已知从事糖尿病护理工作的营养师进行了全国性调查，391人（76%）作出了回应。
在全国范围内，据报告每10万普通人群每周接受营养护理的中位数时间为10.7小时，但各地情况不均衡，每10万人每周的护理时间从2.0小时至27.6小时不等。85%的营养师工作地区每10万普通人群每周的护理时间少于22小时（当前建议的最低标准）。二级护理机构的营养护理服务量更大（每10万普通人群每周中位数为9.1小时），高于全科医疗、养老院及其他场所（每10万普通人群每周中位数为4.4小时）。由指定营养师负责协调糖尿病营养服务的地区，其服务量大于协调员不是营养师或没有协调员的地区。超过90%的营养师报告称遵循英国糖尿病协会（BDA）关于碳水化合物、糖、脂肪和纤维摄入建议，但只有三分之一的人常规提供限盐建议。在继续使用碳水化合物交换法的17%的营养师中，所有人都将这种方法与其他方法结合使用。临床标准小组提出的建议中，只有69%的营养师报告称在四周内见过半数以上新诊断的成年患者，不到50%的人报告称每年为半数或更多患者进行复查。在当前使用的文献中，98%的营养师使用BDA文献来指导患者，90%的人在自身学习中使用BDA出版物。76%的营养师认为商业减肥组织在糖尿病患者体重管理中可发挥作用。
鉴于营养护理在糖尿病管理中的已证实价值，纠正英国糖尿病护理营养服务地区不平等状况将大有裨益。
