We compared the diet of residents with diabetes with current British Diabetic Association (BDA) recommendations, and the nutritional adequacy and content of the diet using 3-day food diaries. We studied 52 residents with diabetes and 48 age- and sex-matched controls from 37 nursing, residential and elderly mentally infirm homes in one city. The daily intake of fat, protein, carbohydrate and fibre of the group with diabetes did not comply with current BDA guidelines, and 52% of diabetic residents and 46% of controls had a lower daily energy intake than currently recommended. The diet of diabetic residents did not comply with current recommendations. Undernutrition is common in both groups.
The effect of dietetic advice on hyperlipidaemia in type 2 diabetic patients is uncertain. We have investigated this modality of treatment in 50 type 2 diabetic patients (24 female), mean (±SD) age 54±4 years and diabetes duration 5±4 years. All had a random plasma total cholesterol concentration of >6.5 mmol/L (mean 7.5±0.7 mmol/L). Three months after dietetic intervention, cholesterol fell to 7.1±1.1 (p=0.049), but triglycerides, LDL‐cholesterol and HDL‐cholesterol were unchanged, as were HbA1c and body mass index (BMI). Thirteen (26%) patients reduced total cholesterol levels to <6.5 mmol/L on dietary treatment (‘diet responders’). In this group there were significant improvements in total cholesterol (6.9±0.3 versus 5.9±0.6, p=0.03) and LDL‐cholesterol (4.8±0.5 versus 4.1±0.5, p=0.003). This group had lower baseline total cholesterol levels than ‘diet non‐responders’. Multiple regression analysis revealed no association between diet response and baseline levels of HbA1c, BMI, age, sex, diabetes duration or compliance with dietetic advice. After two years of follow‐up only four of these 13 ‘diet responders’ had cholesterol levels<6.5 mmol/L without drug treatment. ‘Diet non‐responders’ at 3 months were treated with fenofibrate, which resulted in significant improvements in total cholesterol (7.6±0.9 before versus 6.8±1.1 after, p=0.012), LDL‐cholesterol (5.2±0.8 before versus 4.6±0.8 after, p=0.019) and triglycerides (3.7±2.7 before versus 2.7±1.4 after, p=0.008). HDL cholesterol rose (1.0±0.3 before versus 1.1±0.3 after, p=0.048), and HbA1c also fell from 7.5±1.9 to 6.9±1.8 (p=0.024) on fenofibrate treatment. We conclude that dietary treatment of dyslipidaemia in type 2 diabetes is effective only in a minority of patients, who are characterised by milder degrees of hypercholesterolaemia. Fenofibrate however was effective in improving dyslipidaemia, and was also associated with a reduction in HbA1c. Copyright © 2001 John Wiley & Sons, Ltd.
Background: The clinic was established in 1998 in response to the need for a local service for patients with obesity. It offers a multidisciplinary approach to managing obesity in a secondary care setting. Key members of the team include doctors, dietitians, physiotherapists and nurses. Referral criteria were a body mass index (BMI) >40 or BMI > 35 with two or more comorbidities. Referrals were accepted from primary or secondary care. The aims of the clinic are to halt further weight gain and promote 5-10% weight loss and then weight maintenance over 2 years. There are few published studies looking at the outcomes of hospital-based obesity clinics. Patients referred to such clinics are likely to have made several attempts at weight loss and be considerably heavier than patients presenting in primary care for weight management. The aims of this study were to assess weight change and initial nonattendance rates in patients referred to a multidisciplinary weight management clinic. Methods: Data were collected from 103 consecutive patients referred to the weight management clinic over 7 months starting in March 2005. The data were collected retrospectively from clinical letters. Data collected included initial weight and BMI, weight at 6 and 12 months and the latest weight available if after 12 months. Absolute weight change and percentage change were calculated as well as the number of patients achieving clinically significant weight losses at each of the time points. Results: Initial nonattendance rates to the clinic was 15%. Table 1 shows the weight change at each of the time-points audited:
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