Quality Standards for Diabetes Care Toolkit

Implementation advice

Nutritional advice

Diabetes services should be adequately resourced with registered dietitians who have appropriate training and experience in diabetes prevention and management. When commissioning specialist diabetes services for adults with diabetes, international recommendations state there should be at least at least four whole-time equivalent (WTE) registered dietitians with specialist skills in diabetes for a total population of 250,000 people, with an average of 5% prevalence of diabetes (Commissioning Specialist Diabetes Services for Adults with Diabetes – a Diabetes UK Task and Finish Group Report 2010). This should be upwardly adjusted based on local demographic need (eg, areas with a diabetes prevalence above the national average) and/or increasing prevalence of diabetes and obesity. Local models of care should reflect registered dietitian full-time equivalent (FTE) ratios and be integrated into clinical care pathways, (eg, Map of Medicine see MidCentral and Waikato DHBs).

www.nursingreview.co.nz/issue/may-2012/map-of-medicine-development-at-midcentral-dhb/#.U97BPpSSwwc.

www.waikatodhb.health.nz/about-us/news-and-events/news/midland-dhbs-join-together-with-map-of-medicine/.
As nutritional advice is different for type 1 diabetes, type 2 diabetes, diabetes in pregnancy and across the lifespan, it is important that registered dietitians have the appropriate knowledge and skills to practice competently at the level their role requires. Given the growing prevalence and complexity of diabetes referrals, it is essential that primary, secondary and specialist services are adequately resourced with dietitians who are experts in diabetes and nutritional advice, understand the broader complexities of living with diabetes and also have advanced skills in communication and adult education. With adequate resourcing, dietitians may then be available to support other providers of diabetes care to develop fundamental nutrition knowledge and skills so that, wherever people are accessing care, consistent and accurate dietary advice can be imparted. Implementation of an Integrated Knowledge, Skills and Career Pathway framework is currently being developed for New Zealand dietitians working in diabetes care.