Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services
Lisa Spencer A , Marie-Claire O’Shea B , Lauren Ball C , Ben Desbrow C and Michael Leveritt D EA School of Public Health, Griffith University, Qld 4222, Australia.
B Marie-Claire O’Shea Dietitians, Suite 11, 151 Cotlew Street, Ashmore, Qld 4214, Australia.
C School of Public Health and Griffith Health Institute, Griffith University, Qld 4222, Australia.
D School of Human Movement Studies, The University of Queensland, Brisbane, Qld 4072, Australia.
E Corresponding author. Email: michael.leveritt@uq.edu.au
Australian Journal of Primary Health 20(3) 291-297 https://doi.org/10.1071/PY13021
Submitted: 25 February 2013 Accepted: 19 May 2013 Published: 4 July 2013
Abstract
The aim of the present study was to investigate the participation and weight and waist circumference outcomes of patients with type 2 diabetes (T2D) receiving Medicare-subsidised dietetic services. A prospective observational study was conducted between January and September 2011 involving three private practice dietitians who provided services at 11 medical centres in south-east Queensland. All patients with T2D who were referred by their general practitioner (GP) to one of the dietitians as part of their team care arrangements were asked to participate. Participants’ attendance at consultations was recorded for the study duration. The dietitian collected weight and waist circumference measures at each consultation. In all, 129 participants (mean age 58.9 ± 15.7 years; mean body mass index 32.2 ± 5.6 kg m–2) were included in the study. The most frequent number of consultations allocated to a dietitian was two. Small, but significant reductions in bodyweight (1.9 ± 2.9 kg; P ≤ 0.05) and waist circumference (2.0 ± 4.8 cm; P ≤ 0.05) were observed from the initial to final consultation. Participants who attended more than two consultations lost significantly more weight than those who attended two consultations only (3.7 ± 4.2 vs 1.1 ± 1.6 kg, respectively; P ≤ 0.05). Almost one-third of participants (n = 38; 29%) did not complete the allocated number of consultations available through their referral. Modest weight and waist circumference reductions are achievable for patients with T2D receiving Medicare-subsidised dietetic services. The clinical significance of these reductions requires further investigation. Patients who attend more consultations with a dietitian may experience further improvements in weight and waist circumference outcomes. However, many patients do not complete the number of consultations allocated. Further research is required to explore the determinants of attendance at consultations in order to maximise potential improvements in health outcomes for patients receiving Medicare-subsidised dietetic services.
References
Andrews RC, Cooper AR, Montgomery AA, Norcross AJ, Peters TJ, Sharp DJ, Jackson N, Fitzsimons K, Bright J, Coulman K, England CY, Gorton J, McLenaghan A, Paxton E, Polet A, Thompson C, Dayan CN (2011) Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial. Lancet 378, 129–139.| Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MnmvVOiuw%3D%3D&md5=458f24380e7b0a50cddcd161dce04284CAS | 21705068PubMed |
Ash S, Reeves M, Yeo S, Morrison G, Carey D, Capra S (2003) Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. International Journal of Obesity and Related Metabolic Disorders 27, 797–802.
| Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXkvVWksrk%3D&md5=720e632e22712dab093f854b5c4b826fCAS | 12821964PubMed |
Australian Bureau of Statistics (2012) Australian health survey: first results. Available at http://www.abs.gov.au/ausstats/abs [Verified November 2012]
Australian Government Department of Health and Ageing (2003) ‘Clinical practice guidelines for the management of overweight and obesity: a guide for general practitioners.’ (Commonwealth of Australia: Canberra)
Australian Government Department of Health and Ageing (2012) Chronic disease management (CDM) Medicare items. Available at http://www.health.gov.au/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement [Verified October 2012]
Australian Government Department of Health and Ageing, Medicare Australia (2012) ‘Medicare benefits schedule.’ (Commonwealth of Australia: Canberra)
Cant RP (2010) Patterns of delivery of dietetic care in private practice for patients referred under Medicare chronic disease management: results of a national survey. Australian Health Review 34, 197–203.
| Patterns of delivery of dietetic care in private practice for patients referred under Medicare chronic disease management: results of a national survey.Crossref | GoogleScholarGoogle Scholar | 20497733PubMed |
Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI (2010) Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment–Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ 341, c3337
| Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment–Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 20647285PubMed |
Dengel DR, Kelly AS, Olson TP, Kaiser DR, Dengel JL, Bank AJ (2006) Effects of weight loss on insulin sensitivity and arterial stiffness in overweight adults. Metabolism 55, 907–911.
| Effects of weight loss on insulin sensitivity and arterial stiffness in overweight adults.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XlvFKisLo%3D&md5=bad814c330ee69e1ea037b994eb0ea2aCAS | 16784962PubMed |
Diabetes Australia (2012) Diabetes in Australia. Available at http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia [Verified November 2012]
Dietitians Association of Australia (2011) ‘Evidence based practice guidelines for the nutritional management of type 2 diabetes mellitus for adults.’ (Dietitians Association of Australia: Canberra)
Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming J (2008) Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. Medical Journal of Australia 188, 29–32.
Foster M, Cornwell P, Fleming J, Mitchell G, Tweedy S, Hart A, Haines T (2009) Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners. Australian Journal of Primary Health 15, 326–334.
| Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners.Crossref | GoogleScholarGoogle Scholar |
Franz MJ, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upman P, Bergenstal R, Mazze RS (1995) Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. Journal of the American Dietetic Association 95, 1009–1017.
| Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2Mzos1Oqtw%3D%3D&md5=bc4d72d41e4ad6d0c3940942c88842bfCAS | 7657902PubMed |
Grimmer-Somers K, Dolesj W, Atkinson J (2010) Enhanced primary care pilot program benefits Type II diabetes patients. Australian Health Review 34, 18–24.
| Enhanced primary care pilot program benefits Type II diabetes patients.Crossref | GoogleScholarGoogle Scholar | 20334751PubMed |
Manning RM, Jung RT, Leese GP, Newton RW (1998) The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: four-year follow-up. Diabetic Medicine 15, 497–502.
| The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: four-year follow-up.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3ptlyrtA%3D%3D&md5=5879d7655c98618dda5dc90806aa096cCAS | 9632125PubMed |
Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF (2012) Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Journal of the Academy of Nutrition and Dietetics 112, 1835–1842.
| Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study.Crossref | GoogleScholarGoogle Scholar | 23102183PubMed |
National Health And Medical Research Council (2003) ‘Clinical practice guidelines for the management of overweight and obesity in adults.’ (National Health And Medical Research Council: Canberra)
Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, Curtis JM, Espeland MA, Foreyt JP, Graves K, Haffner SM, Harrison B, Hill JO, Horton ES, Jakicic J, Jeffery RW, Johnson KC, Kahn S, Kelley DE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montgomery B, Nathan DM, Patricio J, Peters A, Redmon JB, Reeves RS, Ryan DH, Safford M, Van Dorsten B, Wadden TA, Wagenknecht L, Wesche-Thobaben J, Wing RR, Yanovski SZ (2007) Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 30, 1374–1383.
| Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial.Crossref | GoogleScholarGoogle Scholar | 17363746PubMed |
Ross SA, Dzida G, Vora J, Khunti K, Kaiser M, Ligthelm RJ (2011) Impact of weight gain on outcomes in type 2 diabetes. Current Medical Research and Opinion 27, 1431–1438.
| Impact of weight gain on outcomes in type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 21599553PubMed |
Shamoon H, Duffy H, Fleischer N, Engel S, Saenger P, Strelzyn M (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine 329, 977–986.
| The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.Crossref | GoogleScholarGoogle Scholar |
UKPDS Group (1990) UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients. Metabolism 39, 905–912.
| UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients.Crossref | GoogleScholarGoogle Scholar | 2392060PubMed |
Webber TD (2012) What is wrong with Medicare? Medical Journal of Australia 196, 18–19.
| What is wrong with Medicare?Crossref | GoogleScholarGoogle Scholar | 22256919PubMed |
Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Archives of Internal Medicine 170, 1566–1575.
| Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXht1yhtr3F&md5=e155c25dd80e836d5dcc96c321687b7aCAS | 20876408PubMed |
World Health Organization (2008) ‘Waist circumference and waist-hip ratio: report of a WHO expert consultation.’ (World Health Organization: Geneva)
World Health Organization (2011) BMI classification. Available at http://apps.who.int/bmi/index.jsp?introPage=intro_3.html [Verified November 2011]
