Community Nutrition and Dietetics
The dietitian plays a key role in the care of people with diabetes. Achieving a healthy diet and lifestyle is the cornerstone of diabetes management .
The CHE Community Nutrition and Dietetics Team
In Community Heath East (CHE), the community nutrition and dietetic team consist of 3.5 whole time equivalents working full-time in diabetes in the adult population. They work with the diabetes nurse specialists, within the primary care setting in line with the HSE Integrated Diabetes Care Programme. They liaise with the secondary endocrinology services in CHE to support optimal integrated care.
The rest of the CHE community nutrition and dietetic team consist of dietitians working within primary care. Community dietitians see patients with Type 2 diabetes in conjunction with the rest of their caseload.
Some areas in CHE may not have a community dietetic service or administration. Waiting lists are subject to resources.
The Community Dietitian's role in diabetes is to:
- devise and deliver evidence based dietetic care and support collaborative patient goal setting.
- empower the individual to develop the skills, knowledge and confidence to self-manage their diabetes.
- deliver a quality assured diabetes self-management education programme.
- work within the multidisciplinary primary care team.
- audit and evaluate the dietetic service provide education to health professional colleagues.
The ICGP Guidelines for Integrated Type 2 Diabetes Care recommend that ideally, all newly diagnosed patients need to be advised by a dietitian within 4 weeks of diagnosis and all people with Type 2 diabetes should have an annual dietetic review.
This may occur via the DISCOVER DIABETES Self-management education programme or an individual appointment.
All patients with diabetes should be offered a place on a self management education programme. The programme in CHE is DISCOVER.
HSE Community Health East Dietetic Diabetes Patient Care Pathway in Primary care
(Adapted from: National HSE Nutrition and Dietetic Care Plan for Type 2 Diabetes in primary care, 2013 )
Patients who may require individual consultation with a dietitian in conjunction with an offer to group SPE:
- Patients with chronic kidney disease
- Patients commencing on insulin
- Patients with diabetes and Coeliac disease
- "Complicated Type 2 diabetes" patients as specified in the ICGP guidelines (1)
This is subject to resources; there may be no community dietetic service in some areas, no administration and waiting lists in others
Dietetic Services for people with Type 2 diabetes in Community CHE
- Individual consultations
- Group programmes
Patients can be referred to the Dietitian for an individual consultation as outlined in the referral guidelines and for any of the following reasons:
1. Refer patients with Type 2 diabetes who would like/need nutrition education on any of the following
Reading food labels
DASH diet (Dietary Approaches to stop Hypertension)
2. Refer patients who would like/need nutrition counselling (behaviour change counselling)
Strategies to overcome emotional eating
Support around self care behaviours
3. Refer patients
With long-standing diabetes with limited prior education
Where there is a change in medication, activity, or nutritional intake
With HbA1c out of target
To help maintain positive health outcomes
With unexplained hypoglycaemia or hyperglycemia
Who are planning pregnancy
With new life situations and competing demands
4. Refer when new complicating factors influence self-management. Change in:
Health conditions such as renal disease and stroke, need for steroid or complicated medication regime
Physical limitations such as visual impairment, dexterity issues, movement restrictions
Emotional factors which may affect appetite
Basic living needs such as access to food, financial limitations
5. Refer when transitions in care occur. Change in:
Living situation e.g. now living alone
Age related changes affecting cognition, self-care etc.
This is subject to resources; there may be no community dietetic service in some areas, no administration and waiting lists in others.
How to refer for individual dietetic consultation?
The self-management education programme for people with type 2 diabetes delivered in CHE is DISCOVER DIABETES. See DISCOVER DIABETES Structured Education Programme for more information. This is open to all people with Type 2 diabetes across CHE. Clients can self refer at 01 2744360 or book online through the HSE website.
The group programme for Weight Management in CHE is PHEW (Programme for Healthy Eating and Weight Management).
PHEW is a 6 week programme run by a community dietitian to support clients with a BMI >28kg/m2 who want to lose weight.
A group education programme for people with pre-diabetes is available in CHE. The programme is delivered by a Diabetes Dietitian and Diabetes Nurse and runs over 3 sessions with session 1 and 2 a week apart and a follow-up session 6 months later.
GPs and PN can refer via a form available from firstname.lastname@example.org. All patients referred are entered onto a register and invited for group education. This is open to all people with pre-diabetes across CHE.
See the Pre-Diabetes section for more information.