10 May 2013
QOF Diabetic Dietary Review
Some words buried in the depths of the diabetes section of nGMS QOF have been exercising the minds of many of our former students recently. The words in question form what is now DM013 and read:
The percentage of patients with diabetes, on the register, who have a record of a dietary review by a suitably competent professional in the preceding 12 months.
The question that has been exercising the minds is just what is a “suitably qualified professional”? Does completing our diploma level Diabetes Management course mean that you are a suitably qualified professional?
This question seems also to have exercised the minds of the people at NICE, or, as we should probably call it now, NIHCE, as they include guidance using up a full page of small print to explain the issue. They say, amongst other things:
“Much of the management and monitoring of people with diabetes is undertaken by GPs and members of primary care teams.” The NICE clinical guideline on type 2 diabetes recommends that patients with type 2 diabetes be provided with individualised and on-going nutritional advice from a healthcare professional with specific expertise and competencies in nutrition that:
- is sensitive to the individual’s needs, culture and beliefs
- emphasises advice on healthy balanced eating
- encourages a diet with high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, whole grains and pulses; that includes low-fat dairy products and oily fish; and controls the intake of foods containing saturated and trans fatty acids.
- targets, for people who are overweight, an initial body weight loss of 5–10 per cent, lesser amounts may still be of benefit, losing more weight in the longer term has metabolic benefits
- individualised recommendations for carbohydrate and alcohol intake, and meal patterns
- limited substitution of sucrose-containing foods for other carbohydrate in the meal plan is allowable, but that care is taken to avoid excess energy intake
- discourages the use of foods marketed specifically for people with diabetes.
The NICE clinical guideline on type 1 diabetes recommends that for patients with type 1 diabetes:
- It is advised that the hyperglycaemic effects of different foods a person with type 1 diabetes wishes to eat is discussed in the context of the insulin preparations chosen to match those food choices.
The choice of content, timing and amount of snacks between meals or at bedtime available to the person with type 1 diabetes is to be agreed on the basis of informed discussion about the extent and duration of the effects of consumption of different food types and the insulin preparations available to match them. Those choices are to be modified on the basis of discussion of the results of self-monitoring tests.
Information is made available on: effects of different alcohol-containing drinks on blood glucose excursions and calorie intake; use of high-calorie and high-sugar ‘treats’; use of foods of high glycaemic index.
All healthcare professionals providing advice on the management of type 1 diabetes are to be aware of appropriate nutritional advice on common topics of concern and interest to adults living with type 1 diabetes and be prepared to seek advice from colleagues with more specialised knowledge. Suggested common topics include:
- glycaemic index of specific foods
- body weight, energy balance and obesity management
- cultural and religious diets, feasts and fasts
- foods sold as ‘diabetic’
- dietary fibre intake
- protein intake
- vitamin and mineral supplements
- matching carbohydrate, insulin and physical activity
- salt intake in hypertension
- co-morbidities including nephropathy and renal failure, coeliac disease, cystic fibrosis or eating disorders
- use of peer support groups.
“The Diabetes UK competency framework for dieticians sets out level one competencies that are the minimum standard for any staff involved in the healthcare of people with diabetes”
It has to be said that this is a long and complicated document running to 66 pages in length but, in fact, as one of our tutors points out, the knowledge required is fairly basic and that our training more than covers the aspects mentioned in the Competency.
But, is it all worthwhile for a measly 3 points?
You can find the competency on our web-site in its complete form here.