Factors associated with consulting a dietitian for diabetes management: a cross-sectional study

Abstract

BackgroundType 2 Diabetes (T2D) has reached epidemic levels in the Middle East region. Despite evidence that it improves health outcomes and saves health costs, dietary counseling for T2D remains grossly under-investigated in this region. The aim of this study was to assess the frequency and determinants of use of dietary counseling services by T2D patients in Lebanon and recommend corrective measures that may guide the planning, organization and delivery of care for chronic diseases in general and diabetes care in particular.MethodsA non-experimental cross-sectional design was utilized to survey outpatients with T2D in two major health centers in Lebanon. Patients diagnosed with T2D were invited to complete a questionnaire consisting of five sections: socio-demographic characteristics, disease attributes, patients’ perceptions regarding T2D management, practice of lifestyle modifications, and referral by a physician to a dietitian. The outcome of interest was the use of dietary counseling services by T2D patients at least once since their diagnosis. Descriptive statistics and logistic regression analyses were used to evaluate the frequency and determinants of dietary counseling services utilization.ResultsA total of 332 T2D patients completed the questionnaire (response rate 94.6%). Although 75% of study participants believed that dietitians can assist them in changing their dietary habits, only 38% had consulted with a dietitian. Among study participants, only 34% were referred to a dietitian by their physician. The main determinants of the use of dietary counseling services were referral by a physician (OR: 112.25; 95% CI = 42.74-294.84), the presence of outpatient social or private health insurance (OR: 5.86; 95% CI = 2.40-14.25) and the belief that a dietitian can assist in changing dietary habits (OR: 3.74; 95% CI = 1.33-10.54).ConclusionsThe findings of this study show suboptimal use of dietary counseling services by T2D patients in Lebanon. Key determinants were physicians’ referral, financial support for outpatient care, and patients’ belief in the usefulness of dietary counseling. Suggested interventions entail enhancing the planning and organization of care through inter-professional collaboration between physicians and dietitians; promoting public financing for high quality outpatient care that includes dietary counseling; and promoting the value of dietary counseling and improving the public image of dietitians.

Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives

“…In their randomized controlled trial, Pritchard et al reported that collaboration between GPs and dietitians led to the most successful weight loss and health promotion when compared to individual practitioner attempts. This was consistent with other reports that combined care between GPs and allied health professionals, such as dietitians, resulting in greater motivation from patients in lifestyle interventions [30,37,38,39]. Our findings indicate routine referral to dietitians supports greater uptake of lifestyle management.…”

“…This contrasts with existing literature on the practice habits from GPs, suggesting limited referrals to dietitians from GPs [34,37,40,41,42]. Patient reluctance to visit dietitians is similarly documented [22,38,40,43,44]. In Australia, CDM plans reduce the complexity of allied health referrals, as it allows GPs to organize five subsidized allied health care visits for patients with chronic disease.…”

“…Discussing lifestyle-related issues, such as confronting overweight patients, has often been met with hesitancy by doctors [37,38,39]. We encountered few GPs that shared these sentiments.…”

Quick guide to type 2 diabetes self-management education: creating an interdisciplinary diabetes management team

“…In a study by Alameddine et al, 15 332 patients with type 2 diabetes completed a questionnaire, and although 75% of study participants believed that dietitians can assist them in changing their dietary habits, only 38% had consulted with a dietitian. Among the study’s participants, only 34% were referred to a dietitian by their physician.…”

“…20 According to the Standards of Medical Care in Diabetes, clinical trials have provided strong evidence for the HbA1c-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes. 15 , 21 One of the main goals of the diabetes prevention program is to exercise for at least 150 minutes every week and lose at least 3% of total body weight. These results have been proven to lower HbA1c levels and prevent type 2 diabetes.…”