Access To And Effectiveness Of Dietetic Services For People With Type 2 Diabetes

Abstract

Nutrition therapy is central to the management of type 2 diabetes and Accredited Practising Dietitians have the expertise to best deliver this type of health care. Yet, some people with type 2 diabetes never consult with a dietitian. This research used a mixed-methods approach to assess the effectiveness of dietetic services and to elucidate the enablers and the barriers to access to these services for people with type 2 diabetes. Chapter 1 provides the context for this research by introducing the problem of type 2 diabetes mellitus and the strategies for its management with emphasis on diet. Chapter 2 summarises the methods. Chapters 3 and 4 respectively present the clinical- and cost-effectiveness evidence of dietetic interventions for type 2 diabetes. Nutrition interventions led by dietitians improve glycaemia more than when led by other healthcare professionals and are cost-effective, reducing hospitalisation costs and sick days at work and at home. Chapter 5 describes the inequitable access to dietetic services in Australia, with rural, remote and areas of lower socioeconomic status having higher prevalence of type 2 diabetes but less dietitians. The next chapters discuss the experiences and perspectives of people with type 2 diabetes (Chapter 7) and of dietitians (Chapter 6) and doctors (Chapter 8) that treat them, in regard to the access to and delivery of dietetic services for these people. Patients report that dietitians, social support and health literacy facilitate their dietary change. Although dietitians report a lack of referrals from doctors, doctors report preferring to refer their patients to a dietitian, but often not doing so due to lack of available services, inability to afford services or lack of motivation by patients. Chapter 9 reports on the utilisation of dietetic services in Australia. Chapter 10 collates the evidence from this research into recommendations for policy-makers. Finally, Chapter 11 highlights areas for future research.