Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Benchmarking Australian Adult Dietetic Services for Nutrition Management of Type 1 Diabetes Mellitus (#355)

Claire Waugh 1 , Helen d'Emden 1 2 , Barbara Van der Meij 3 4 , Neisha D'Silva 1 , Trisha O'Moore-Sullivan 5
  1. Mater Health, South Brisbane, QLD, Australia
  2. Mater Research Institute-The University of Queensland, Brisbane, Qld, Australian
  3. Nutrition and Dietetics, Mater Group, Brisbane, Qld
  4. Faculty of Health Science and Medicine, Bond University, Robina, Qld, Australia
  5. Medical/Chronic Disease Services, Mater Health, Brisbane, Qld, Australia

Aims: Nutrition management is an integral part of type 1 diabetes mellitus (T1DM) care. However, there is limited information on whether diabetes services are meeting guidelines and the optimal dietitian to patient ratios. We aim to benchmark tertiary T1DM services for adults (> 16 years, excluding obstetric) to inform service improvement.

Methods: In 2016 surveys were sent to 29  hospitals in Australia with a T1DM service. Information on service profile, T1DM management, dietitian (full time equivalents), referral systems, nutrition management plans, and scope of dietitian practice was collected.

Results: The benchmark response rate was 19 (65.5 %). Only 36.8% centres used a database to inform patient numbers and service profile. All centres had a dietitian and multidisciplinary team. The most common forms of insulin management were flexible multiple daily injections  (59.7%) and pump therapy (23.6%), with fixed dose therapies 12.5%. Care  pathways accounted for 33.3% of inpatient and 38.9% of outpatient referrals. Nutrition management plans were used by 21.1% (new diagnosis) and 5.3% (ongoing management). A median of 55% (range 30-90%)  patients were seen by a dietitian at least annually. Dietitian scope of practice was consistent across centres with general nutrition, carbohydrate counting, exercise, hypoglycaemia and alcohol (100%). Education using dosing tools was provided by 84.2% dietitians. A structured evidence based group program was offered by 42.1% of centres. Insufficient data prevents conclusions being drawn for dietitian to patient ratios.

Conclusions:  This survey informs on tertiary T1DM services for adults in Australia and shows that many centres are meeting guidelines around multidisciplinary care, flexible insulin therapies and scope of practice. There are gaps in providing a structured management plan for newly diagnosed, meeting annual review guidelines and providing structured group education. Shared, standardised data systems are needed for service development and to guide staffing requirements for best practice.