Dietitians in primary care promote weight loss and glycated haemoglobin reductions

Background:  Obesity is a major public health issue; approximately two‐thirds of UK adults are overweight or obese; this figure is predicted to continue to rise (Department of Health, 2008). Type 2 diabetes is the most common obesity‐related co‐morbidity (Department of Health, 2008). It has been shown that intensive diet and lifestyle advice has the potential to improve weight and glycated haaemoglobin (HbA1c) in patients with type 2 diabetes (UKPDS, 1998). The aim of this pilot project was to evaluate the effectiveness of dietetic intervention in general practitioner (GP) practices in a rural setting, for overweight patients and patients with type 2 diabetes. Methods:  Between June 2009 and June 2010, overweight and patients with type 2 diabetes were referred to a weekly dietetic clinic in six rural GP practices for one‐to‐one consultations. One dietitian carried out all consultations and collected all weight and height measurements. HbA1c results were collected from results recorded on the GP computer systems. To evaluate the success of the pilot, the dietitian carried out a review of all consultations and a comparison between baseline and post‐intervention measurements. Mean (SD) change were recorded for HbA1c, weight and body mass index (BMI). t ‐tests were used to test statistical significance using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Results:  A total of 541 patients were seen by the dietitian on an average of two occasions. The mean age was 59 years; 44% ( n  = 238) patients were male. The dietetic consultations resulted in significant reductions in weight, BMI and HbA1c. Results for weight, BMI and HbA1c are shown in Table 1. 1  Outcomes for dietitian in rural GP practicesMeasures Baseline 1 year Range Mean (SD) change PHbA1c (%) 7.8 7.2 +1 to −6 −0.6 (0.9) 0.003 Weight (kg) 104.6 102 +4 to −17 −2.6 (3.4) 0.06 BMI (kg m −2 ) 37.1 36.2 +1.3 to −6.9 −0.9 (1.2) 0.05Discussion:  It is well documented that any reduction in HbA1c is likely to reduce the risk of diabetic complications and that modest weight losses of 5–7% can reduce the risks of developing diabetes in the overweight (DPP, 2002). The results achieved here are comparable with the Lifestyles Over and Above Drugs (LOADD) study (Coppell et al ., 2010), where the average reduction in HBA1c was 0.4% and a weight loss of 1.3 kg. The results here have been achieved in an average of 2.0 consultations and, although the results are modest, they can bring about clinical improvements for patients. Conclusions:  This pilot project has shown that a dietitian based in rural GP practices, giving evidence‐based advice to patients regarding weight management and type 2 diabetes, can be effective in producing modest reductions in weight and reductions in HbA1c to a level that may produce health benefits. References:  Coppell, K., Kataoka, M., Williams, S., Chisholm, A., Vorgers, S. & Mann, J. (2010) Nutritional intervention in patients with type 2 diabetes who are hypergylcaemic despite optimized drug treatment – Lifestyles Over And Above Drugs (LOADD study): randomised controlled trial. BMJ 341 , c3337. Cross‐government department Obesity unit, Department of Health, Department for Children, Schools and Families (DCSF) (2008) Healthy Weight, Healthy Lives: A Cross Government Strategy for England, Guidance for Local Areas, A Toolkit for Developing Local Strategies. London, Department of Health. The Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Eng. J. Med. 346 , 393–403. UKPDS Group (1998) Intensive blood‐glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352 , 837–835.