Hello and happy Dietitians Week! The British Dietetic Association have set this year’s hash tag across social media as #WhatDietitiansDo, to highlight the roles that Dietitians play across the NHS, private and third sectors, so we thought we would share some information about a brand new dietetic role and team in NHS Ayrshire & Arran. Our new team is made up of an Advanced Weight Management Dietitian, a Diabetes Prevention Specialist Dietitian and two Diabetes Prevention Dietitians. Together we form the new Dietetic Diabetes Prevention Team.
In 2017 the Scottish Government announced a £42 million investment over the next five years into the provision of weight management services for those with, or at risk of type 2 diabetes, and subsequently developed the framework; ‘A Healthier Future – Framework for the Prevention, Early Detection and Early Intervention of type 2 diabetes’. For more information you can view this framework and the closely linked ‘A Healthier Future – Scotland’s Diet & Healthy Weight Delivery Plan’8,9.
NHS Ayrshire & Arran are an early adopter Board for the implementation of the framework and this is led by our Consultant Dietitian in Public Health Nutrition. The Dietetic Diabetes Prevention Team has only been in post for a month, so the project is in its early days. The aim of the framework is to provide suitable, evidence based, effective and equitable weight management services across the local area. The important statistics are (hopefully!), well known by now;
- In 2018 there were 300,000 people in Scotland living with type 2 diabetes, with an additional 30,000 cases likely to be undiagnosed1.
- It is estimated that approximately 500,000 people in Scotland are at high risk of developing type 2 diabetes2.
It’s clear that there’s a huge opportunity to make an impact on these numbers.
So, what are the risk factors for developing type 2 diabetes?
The main modifiable risk factor is weight and consequently body mass index (BMI). Having a BMI greater than 25kg/m2 is the main risk factor for diabetes3, for this reason the investment from the Scottish Government focuses on the implementation of weight management services. In 2016 the Scottish Health Survey highlighted that two thirds of adults are now overweight with almost one third being categorised as obese (with a BMI of >30kg/m2)4. In Ayrshire and Arran this translates to 70% of all adults being classed as overweight or obese5.
In addition, we know that being physically active can improve both our physical and mental health and can help to reduce the risk of developing type 2 diabetes10. The guidelines published in 2011 report that the population should be aiming for either 75minutes of vigorous physical activity per week or 150minutes of moderate physical activity per week; or a combination of both12. It is vital to reiterate as Ayrshire & Arran falls below the average of the Scottish population with 60% of adults meeting the recommended physical activity guidelines13 compared with the 64% Scottish average, in regular moderate to vigorous physical activity to meet the guidelines5.
It is important to focus on reducing health inequalities; data published by the Scottish Government in 2014 highlights that those from areas of higher social deprivation have higher rates of obesity with 32% of adults living in the most deprived areas classified as obese compared with 20% in the least deprived areas6. These areas also have the highest rates of physical inactivity and unhealthier diets6.
Although the programme is very much in its infancy, at present we are undertaking scoping work to understand the prevalence of pre diabetes and those at high risk of developing pre-diabetes at primary care level. Once gathered the information will direct us towards the areas in Ayrshire where we need to focus our initial community engagement and delivery on, to ensure we have tried and tested the programme before rolling out Pan-Ayrshire. We are planning on offering individuals who are at risk of developing type 2 diabetes planned group education, individual support from a Dietitian and guidance on maintaining a healthy weight and being more physically active. We are also working with colleagues in midwifery to improve care for pregnant women at risk of developing gestational diabetes. We will provide longer term follow up and weight management support to women who have had gestational diabetes after the birth of their baby.
Type 2 diabetes has a significant impact at an individual and national level. Consequences range from the complications and burden of the disease and impact this has on the quality of life, to the cost implications of medications. In fact, the NHS spends around 9% of overall health expenditure on type 2 diabetes7.
Do you know your risk of developing type 2 diabetes? Click here to find out. . It doesn’t take long, and it could be the most important thing you do today.
Contributed by:
Ruth Campbell, Consultant Dietitian in Public Health Nutrition (@RuthCampbellPHN)
Lorna Breeze, Diabetes Prevention Specialist Dietitian (@LornaEBreezeRD)
Rhona MacLean, Diabetes Prevention Dietitian
Doug Stewart, Diabetes Prevention Dietitian (@DougStewartRD)
References:
- Diabetes UK (2019). Diabetes Prevalence 2018. Available from: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics/diabetes-prevalence-2018 [Accessed 31st May 2019].
- 2. Diabetes UK Position Statement (2014). Type 2 Diabetes Prevention & Early Identification. Available from: https://www.diabetes.org.uk/professionals/position-statements-reports/type-2-diabetes-prevention-early-identification [Accessed 31st May 2019]
- Scarborough, P., Bhatnagar, P., Wickramasinghe, K.K., Allender, S., Foster, C. & Rayner, M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: 2006-2007 costs. Journal of Public Health 2011; 33 (4): 52-533
- Scottish Government (2017) The Scottish Health Survey 2016, volume 1, main report. Available from: http://www.gov.scot/resource/0052/00525472.pdf [accessed 3rd June 2019].
- Scottish Government (2017). The Scottish Health Survey: results for local areas 2013 to 2016. Available from: https://www.gov.scot/publications/scottish-health-survey-results-local-areas-2013-2014-2015-2016/pages/3/ [Accessed 4th June 2019].
- Scottish Government (2014). Diabetes Improvement Plan. Available from: http://www.diabetesinscotland.org.uk/Publications/Diabetes_Improvement_Plan_2014.PDF [Accessed 3rd June 2019].
- Hex, N., Barlett, D., Wright, M., Taylor, M., Varley, D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK including direct health costs and indirect societal and productivity costs. Diabetic Medicine. 2012; 27 (7): 855-862.
- Scottish Government (2018). A Healthier Future: type 2 Diabetes prevention, early detection and intervention: framework. Available from: https://www.gov.scot/publications/healthier-future-framework-prevention-early-detection-early-intervention-type-2/ [Accessed 30th May 2019]
- Scottish Government (2018). A Healthier Future: Scotland’s diet and healthy weight delivery plan. Available from: https://www.gov.scot/publications/healthier-future-scotlands-diet-healthy-weight-delivery-plan/ [Accessed 30th May 2019].
- Scottish Government (2018). A More Active Scotland: Scotland’s Physical Health Delivery Plan. Available from: https://www.gov.scot/publications/active-scotland-delivery-plan/ [Accessed 4th June 2019]
- Department of Health and Social Care (2011). Start Active, Stay Active Delivery Plan: Report on Physical Activity in the UK. Available from: https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers [Accessed 4th June 2019]
- Department of Health (2011) Factsheet 4: Physical Activity Guidelines for Adults (19-64 years) Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213740/dh_128145.pdf
- Department of Health (2011) Start Active, Stay Active: A report on physical activity for health for the four home countries’ Chief Medical Officers. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf
AHPs across health and social care. 
Great example of dietetic leadership & a public health approach- working further upstream & integrating prevention with early detection & intervention.