McArdle P D, Greenfield S M, Avery A, Adams G G, Gill P S
Birmingham Community Healthcare NHS Foundation Trust (BCHC), Birmingham, UK.
Primary Care Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
J Hum Nutr Diet. 2017 Jun;30(3):385-393. doi: 10.1111/jhn.12436. Epub 2016 Nov 7.
Carbohydrate is accepted as the principal nutrient affecting blood glucose in diabetes; however, current guidelines are unable to specify the optimal quantity of carbohydrate for glycaemic control. No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. The present study aims to improve understanding of the degree of variation in the current practice of UK registered dietitians (RDs) by describing how RDs advise patients.
UK RDs were contacted through national networks and asked to complete an online survey, which was analysed using stata, version 12 (StataCorp, College Station, TX, USA). Three consultations between dietitians and patients with type 2 diabetes were observed, followed by semi-structured interviews with the dietitians.
In total, 320 complete survey responses were received. Dietitians' advice varied according to expertise, training and confidence, and the complexity of the patient's blood glucose treatment. Some 48% (n = 154) of respondents advised patients to restrict carbohydrate intake either occasionally or frequently, with 35.6% (n = 114) considering 30-39% of total energy from carbohydrate to be a realistic expectation. The overall theme from the interviews was 'Conflicting Priorities', with three sub-themes: (i) how treatment decisions are made; (ii) the difference between empowerment and advice; and (iii) contradictory advice. A disparity existed between what was observed and interview data on how dietitians rationalise the type of carbohydrate advice provided.
Dietitians' advice varies for a number of reasons. Consensus exists in some areas (e.g. carbohydrate awareness advice); however, clear definitions of such terms are lacking. Clarification of interventions may improve the consistency of approach and improve patient outcomes.
碳水化合物被认为是影响糖尿病患者血糖的主要营养素；然而，目前的指南无法明确控制血糖所需的最佳碳水化合物摄入量。尚无研究描述医疗保健专业人员在为2型糖尿病患者提供碳水化合物建议方面的当前做法。本研究旨在通过描述注册营养师（RD）如何为患者提供建议，增进对英国注册营养师当前做法差异程度的理解。
通过全国性网络联系英国的注册营养师，要求他们完成一项在线调查，使用Stata 12版软件（美国德克萨斯州大学站市StataCorp公司）进行分析。观察了营养师与2型糖尿病患者之间的三次咨询过程，随后对营养师进行了半结构化访谈。
共收到320份完整的调查问卷回复。营养师的建议因专业知识、培训和信心以及患者血糖治疗的复杂性而异。约48%（n = 154）的受访者建议患者偶尔或经常限制碳水化合物摄入，35.6%（n = 114）认为碳水化合物提供的能量占总能量的30 - 39%是一个现实的预期。访谈的总体主题是“相互冲突的优先事项”，包括三个子主题：（i）如何做出治疗决策；（ii）赋权与建议之间的差异；（iii）相互矛盾的建议。在营养师如何合理化所提供的碳水化合物建议类型方面，观察结果与访谈数据之间存在差异。
营养师的建议因多种原因而异。在某些领域（如碳水化合物认知建议）存在共识；然而，缺乏对此类术语的明确界定。明确干预措施可能会提高方法的一致性并改善患者预后。
