School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
J Hum Nutr Diet. 2022 Feb;35(1):179-190. doi: 10.1111/jhn.12939. Epub 2021 Aug 27.
Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines.
Semi-structured interviews were conducted with 12 UK-registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis.
Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low-carbohydrate, low-fat, low-glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient-centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence.
The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.
2 型糖尿病（T2DM）的饮食指南强调体重管理和个体化总碳水化合物摄入量。关于 T2DM 管理最有效的饮食模式（DPs）的证据参差不齐，这可能导致营养师提供的建议有所不同。本研究旨在探讨营养师向 T2DM 成人提供 DP 建议的实践，并了解他们在向患者提供被认为对血糖管理有效的 DP 或遵循当前指南推荐的 DP 时的看法。
对 12 名具有咨询 T2DM 成人经验的英国注册营养师进行了半结构式访谈。营养师被要求对推荐用于 T2DM 血糖管理的五种 DP 发表意见。使用演绎和归纳主题分析对访谈记录进行分析。
确定了九个主题，这些主题提请注意 DP 建议提供的做法、五种 DP（低碳水化合物、低脂肪、低血糖指数、地中海饮食和停止高血压的饮食方法）、其他 DP、DP 建议提供和遵循的障碍和促进因素，以及影响 DP 建议提供的因素。参与者目前向 T2DM 患者提供 DP 建议的做法被认为是个体化和以患者为中心的。参与者讨论了他们目前的实践以及对现有证据的看法，以及患者对被证明对血糖管理有效的 DP 建议的反应。确定了提供特定 DP 建议的几个障碍，包括安全性和合规性挑战。参与者还强调了促进特定 DP 建议和帮助患者遵循这些建议的因素，包括社会支持、教育资源和更有力的科学证据。
本研究的结果提供了有关营养师对向 T2DM 患者推广整个 DP 的看法的重要见解。在制定未来的饮食实践指导方针时，应考虑出现的障碍和促进因素，以支持患者遵循整个 DP 来管理 T2DM。
