How does the utilization of diabetes dietitian and educator service in Saudi Arabia affect glycemic outcomes?

Abstract

BACKGROUND: Despite the acknowledgment that the services of diabetes educator and dietician affect outcome, the level of utilization of these services in the Saudi Arabian public health-care system is not known. The aims of the study were to establish the percentage of patients with diabetes mellitus (DM) followed up by a diabetic educator and a dietician in a tertiary center in Saudi Arabia and associations between follow-up by a diabetic educator and a dietician and glycemic control. MATERIALS AND METHODS: This was a cross-sectional study of 490 diabetic patients who attended the diabetic outpatient clinic consecutively at a public health-care institution in Riyadh. Patients answered interview questions on clinicodemographic variables and diabetic educator or dietitian follow-up during their care. Hemoglobin A1C (HbA1C [%, mmol/mol]) and fasting blood glucose (mg/dL, mmol/L) levels were recorded. RESULTS: The majority of patients were male (68.8%), Saudi (71%), married (91.6%), high school or college educated (55.5%), had type 2 DM (85.5%), and were taking oral hypoglycemics (57.3%). 69.0% and 19.8% of the patients had had at least some follow-up with a diabetic educator and dietician, respectively. HbA1C levels were significantly lower in patients who had had a follow-up with a dietitian (9.1 ± 4.5% [76 ± 26 mmol/mol] vs. 7.8 ± 2.2% [62 ± 13 mmol/mol]; unadjusted odds ratio [OR]: 0.80, 95% confidence intervals [CIs]: 0.71–0.89, P < 0.0001), including in multivariable analysis (adjusted OR: 0.84, 95% CIs: 0.72–0.99, P = 0.04). Follow-up with a diabetic educator was not associated with glycemic control. CONCLUSIONS: Follow-up with a diabetic dietitian had the greatest impact on glycemic control in type 1 and type 2 DM patients. A review of the national standards of best practice of diabetes education and nutrition in Saudi Arabia is required to optimize the outcomes.