Type 2 diabetes Resources

Diabetes in the UK has topped five million, of which 90% of those diagnosed have type 2 diabetes (Wise, 2023). These figures have demonstrated an increase of 148,951 from those recorded in 2020–22, with an estimate that potentially a further 2.4 million people are at high risk of developing type 2 diabetes (Diabetes UK, 2023). The National Diabetes Inpatient Audit has shown that 18% of all hospital beds on any one day are occupied by people who have a diagnosis of type 2 diabetes (NHS Digital, 2020). Apart from healthcare costs attributed to age, financial costs of managing diabetes by the National Health Service is around £10 billion a year (NHS England, 2022), with late recognition of the condition being a contributory factor to rising costs (Diabetes UK, 2023). Those people with late recognition or poorly managed diabetes are at risk of developing cardiovascular diseases, which are the most prevalent cause of mortality and morbidity among people with type 1 and 2 diabetes (Orasanu and Plutzky, 2009; Ma et al, 2022). Achievement of good glycaemic control is fundamental to the prevention of complications due to diabetes — although worldwide it is recognised that only 50% of those with diabetes achieve good glycaemic control (Pastakia et al, 2017).

This article provides an update on the dietary management of type 2 diabetes mellitus (T2DM) for community nurses. Dietary change can greatly modify the trajectory of T2DM. Weight changes are a key factor, as significant weight loss can put the condition into remission, and even less dramatic weight loss can have positive effects on glycaemic control and cardiovascular risk factors in individuals with T2DM. Protein intake supports various aspects of glycaemic management and is an especially important nutrient for older adults, who are more prone to T2DM. Carbohydrate restriction is widely advised in clinical practice, although current guidelines do not support this as the sole dietary management strategy for T2DM; it is simply one of various potentially effective measures. Carbohydrate quality is important and high fibre carbohydrates are the preferred source. Excessive alcohol intake can exacerbate T2DM via its damaging effects on the liver. Knowledge of the dietary management of T2DM is vital for community nurses, as it allows them to offer advanced and comprehensive care to their patients.

This articles deals with the dietary advice that should be provided to people with type 2 diabetes by anyone working in the community (it does not cover advice on physical activity or prevention of type 2 diabetes). If a patient with type 2 diabetes is overweight or obese, the most important factor is to lose weight — even a 5–10% weight loss can improve insulin sensitivity and hence diabetic control. Other factors that are considered in this article are the type of carbohydrate that can be eaten, with wholegrain/high-fibre, lower glycaemic index starches being the best option (the glycaemic index measures the effect of carbohydrates on blood glucose level). Although sugar provides 'empty calories' (food that supplies energy but negligible nutrition) and can result in weight gain, it does not contribute to diabetes directly. Cholesterol levels should be reduced by eating the correct fats, and salt levels should be kept to below 6g a day.

Vivien Ogden describes the need for collaboration between community nurses, doctors and chiropodists in order to offer optimum foot care to elderly patients with type 2 diabetes.

Angie Jefferson reviews recent developments in dietary management of CHD, highlights major studies and outlines a practical approach to dietary change for the nurse practitioner.
Angie Jefferson BSc, RD, RPHNutr is a Consultant Dietician based in Berkshire.
Article accepted for publication: March 2008