14th November 2024
World Diabetes Day: Empowering Dietary Strategies for Your Diabetes Patients.
Introduction: The Role of Primary Care in the Diabetes Epidemic
As we approach another World Diabetes Day, I want to reach out to all of you in primary care, where diabetes management truly begins. Right now, nearly 5 million people in the UK live with Type 2 diabetes and this number is expected to reach 5.5 million by 2030 (Diabetes UK, 2023). The impact on certain communities is even more profound, with South Asian, Chinese, Black African, and Black Caribbean populations experiencing a two- to four-fold increased prevalence of Type 2 diabetes. These groups often face severe complications earlier than their White counterparts, making early and effective intervention essential (Diabetes UK, 2023; NICE, 2023; Public Health England, 2021).
The scale of this epidemic is daunting, but the impact you can have is enormous. Beyond medications, one of the most powerful tools we have in diabetes care is diet. Thoughtful, evidence-based dietary interventions can lead to significant improvements in glycaemic control, reduce or even eliminate the need for certain medications, achieve remission, reduce complications and improve quality of life for our patients. Let’s talk about some of these dietary strategies and how, by working together, we can create lasting, positive change for our patients with diabetes.
Evidence-Based Dietary Approaches: A Toolkit for Primary Care
There’s a range of dietary strategies with proven benefits in managing diabetes, each adaptable to the needs of your diverse patient populations. Here’s a quick look at some approaches that may align well with your patients’ lifestyles and preferences:
- Low-Carbohydrate Diets (LCDs)
Reducing carbs is one of the fastest ways to bring down glucose spikes and improve HbA1c levels. For some patients, an LCD can even lead to diabetes remission and reduced medication needs. A great choice for patients interested in a straightforward approach (Diabetes UK, 2022; Unwin et al., 2020). - The Mediterranean Diet
This heart-healthy diet emphasizes fruits, vegetables, whole grains, lean proteins, and olive oil—an approach linked to improved insulin sensitivity and cardiovascular health (Esposito et al., 2015). The Mediterranean diet can also be paired with principles from the DASH Diet, further enhancing its protective benefits for cardiovascular health. Many patients find it accessible and enjoyable, which can support long-term adherence. - Very Low-Calorie Diets (VLCDs)
VLCDs, like the regimen tested in the UK’s DiRECT trial, offer rapid weight loss and glycaemic control benefits. These diets require close support but have yielded remission in nearly 50% of newly diagnosed patients (Lean et al., 2018). With the right follow-up and monitoring, VLCDs are a powerful option, particularly for patients newly diagnosed or motivated for intensive intervention. - Intermittent Fasting (5:2 Diet)
The 5:2 fasting approach, which involves reduced intake on two non-consecutive days, can help improve insulin sensitivity and stabilise glucose levels (Patterson & Sears, 2017). Patients looking for flexibility may appreciate this approach, though close guidance is needed to ensure balanced nutrition.
Personalised, Person-Centred Care: Tailoring Diets to Real Lives
The key to success with any dietary approach is personalisation. We know there’s no “one size fits all” for dietary interventions, especially given the wide diversity in cultural backgrounds, preferences, and lifestyles of our patients. Primary care teams are perfectly placed to offer this nuanced support and to make dietary advice relevant and accessible for each patient. When working with high-risk groups, culturally tailored advice is essential for real engagement and adherence (Khunti et al., 2020).
Closing Knowledge Gaps: Upskilling for Better Dietary Support
We know that diet plays a critical role: as part of the multidisciplinary team (MDT), dietitians can offer valuable support, but empowering all HCPs with targeted training on these dietary interventions can go a long way. CPD courses, focused resources, and even a few minutes of dedicated dietary discussion during a routine consultation can make all the difference in patient outcomes.
At Education for Health we ensure that our diabetes courses focus on dietary interventions by integrating evidence-based nutrition science with practical training. This approach enhances healthcare professionals’ knowledge and equips them with the skills to implement and tailor effective dietary strategies for their patients, ultimately improving health outcomes.
Collaboration and the Way Forward
The rising tide of diabetes is challenging, but it’s also a call to action. By working together within an MDT, we can develop person-centred, sustainable approaches to diabetes care that make the best use of dietary strategies. Each one of you has the power to lead dietary conversations and inspire change. With evidence-based dietary advice and a collaborative mindset, we can provide our patients with the tools they need to take control of their health.
Let’s make dietary interventions a top priority in our diabetes care, improving glycaemic control, reducing complications, achieving remission and transforming lives.
By Chanda Pattni, RD, Diabetes Specialist Dietitian, Freelance Associate for Education for Health
Find out more about the diabetes courses we offer.
References
Diabetes UK. (2023). Diabetes in the UK 2023: Prevalence and statistics. Retrieved from https://www.diabetes.org.uk/
Esposito, K., Kastorini, C. M., Panagiotakos, D. B., & Giugliano, D. (2015). A journey into a Mediterranean diet and type 2 diabetes: A systematic review with meta-analyses. BMJ Open, 5(8), e008222. https://doi.org/10.1136/bmjopen-2015-008222
Khunti, K., Camosso-Stefinovic, J., Carey, M., Davies, M. J., Dallosso, H., Dixon, S., & Skinner, T. C. (2020). Effectiveness of culturally tailored diabetes education for individuals of South Asian origin: A systematic review and meta-analysis. Diabetic Medicine, 37(6), 901–917. https://doi.org/10.1111/dme.14268
Lean, M. E. J., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., & Taylor, R. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. The Lancet, 391(10120), 541-551. https://doi.org/10.1016/S0140-6736(17)33102-1
National Institute for Health and Care Excellence (NICE). (2023). Type 2 diabetes in adults: Management. Retrieved from https://www.nice.org.uk/guidance/ng28
Patterson, R. E., & Sears, D. D. (2017). Metabolic effects of intermittent fasting. Annual Review of Nutrition, 37, 371-393. https://doi.org/10.1146/annurev-nutr-071816-064634
Public Health England. (2021). Diabetes prevalence and risk factors in England. Retrieved from https://www.gov.uk/government/publications
Unwin, D., Haslam, D., & Livesey, G. (2020). It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance, 5, a423.