Carbohydrate Awareness Advice
Research type
Research Study
Full title
CAADDi - Carbohydrate Awareness Advice by Dietitians in Diabetes
IRAS ID
201232
Contact name
Paul D McArdle
Contact email
Duration of Study in the UK
1 years, 4 months, 27 days
Research summary
Carbohydrate Awareness Advice by Dietitians in Diabetes (CAADDi).
Over 3 million people in the UK have diabetes, most of which have type 2 diabetes, and the condition has huge personal and financial costs. Diet plays an crucial role in the management of type 2 diabetes and has demonstrated significant benefits in improving diabetes outcomes.Carbohydrate (found in starchy foods like bread, pasta, potatoes and rice as well as all forms of sugar: natural or added) is the main nutrient that will cause the blood glucose (type of sugar in the blood) to rise. However research has been unable to state how much carbohydrate people with diabetes should eat in order to get the best health outcomes. This has left some professionals, including dietitians, uncertain how to advise patients about carbohydrate.
This community-based research study will interview adults (18+ years) with diabetes who have previously received advice from dietitians to understand their experience of this advice. In particular, what was helpful or unhelpful about the advice and how they’ve used it in making decisions about what to eat.
In addition, focus groups (a group interview / discussion) will be held with dietitians who see people with diabetes in one to one consultations. This will be used to understand how dietitians decide how they are going to advise different types of patients about carbohydrate.
The findings from all of this will be brought together to develop a framework for advising patients about carbohydrate, called ‘Carbohydrate Awareness Advice’. Therefore, the overall aim is to encourage consistency amongst health professionals, provide clearer advice for patients and hopefully better health outcomes for patients. This research is part of a PhD (research doctorate) and will run until February 2018, but data collection will be complete by September 2017.
Lay Summary of Results:
People with Type 2 diabetes are often advised to make changes to the amount and type of carbohydrate they eat, as carbohydrate has the greatest effect on blood glucose levels. However, there is uncertainty about the best way for healthcare professionals to provide this advice, and previous research has shown that dietitians do not always use the same approach. This study aimed to understand the experiences, views and preferences of both people with Type 2 diabetes and Registered Dietitians in relation to carbohydrate advice.
The research involved interviews with 15 people living with Type 2 diabetes and focus groups with Registered Dietitians from across the United Kingdom. Participants were asked about their experiences of dietary advice, their understanding of carbohydrate, and their views on what makes advice helpful or unhelpful.
People with Type 2 diabetes generally valued the support they received from dietitians, but many found the concept of carbohydrate confusing. Participants often understood carbohydrate through a “sugar” perspective and tended to associate it mainly with foods such as bread, potatoes and sugary foods. Many struggled to recall specific carbohydrate advice they had previously received. Patients reported that the most helpful advice was practical, easy to understand, and tailored to their own circumstances, lifestyle and food preferences. They particularly valued dietitians who listened, respected their existing knowledge, and avoided a judgemental or patronising approach.
Dietitians agreed that carbohydrate is an important topic in diabetes management but described a wide variation in how they approached it. Although there was no consensus on the exact amount of carbohydrate people should eat, dietitians consistently emphasised the importance of individualising advice. They described “carbohydrate awareness” as helping people understand which foods contain carbohydrate, how carbohydrate affects blood glucose levels, and how to make informed food choices. Dietitians also identified challenges including conflicting information available to patients, differences in professional opinions, and the need for clearer and more consistent language when discussing carbohydrate.
An important finding was that patients and dietitians appeared to have different understandings of what “individualised advice” means. Dietitians often viewed individualisation as adapting information to a patient’s knowledge and clinical needs. Patients, however, wanted advice that reflected their daily lives, personal preferences, cultural influences and social circumstances. This difference may contribute to dissatisfaction or misunderstandings during consultations.
The findings suggest that effective carbohydrate advice should be person-centred, practical and flexible rather than focused on a single dietary approach. The research was used to develop a Carbohydrate Awareness Advice Framework, which provides a structured approach to discussing carbohydrate with people who have Type 2 diabetes. This framework may help improve consistency in practice and support future research into diabetes dietary care.
Has the registry been updated to include summary results?: No
If yes - please enter the URL to summary results:
If no – why not?: The study is not on a registry.
Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Yes
If yes, describe or provide URLs to disseminated materials: The findings from the study were shared at study days and conferences for diabetes.
If pending, date when dissemination is expected:
If no, explain why you didn't follow it:
Have participants been informed of the results of the study?: Yes
If yes, describe and/or provide URLs to materials shared and how they were shared: Participants were sent a summary of the findings.
If pending, date when feedback is expected:
If no, explain why they haven't:
Have you enabled sharing of study data with others?: No
If yes, describe or provide URLs to how it has been shared:
If no, explain why sharing hasn't been enabled: Qualitative data and recordings have not been made available.
Have you enabled sharing of tissue samples and associated data with others?: No
If yes, describe or provide a URL:
If no, explain why: N/A
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Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
16/YH/0192
Date of REC Opinion
9 May 2016
REC opinion
Favourable Opinion