Dietitian GP Referral Response Letter

1 November 2024 Dear Dr. Sarah Jenkins RE: Smith, Jane DOB: 15/03/1985 Thank you for your kind referral of Jane Smith for nutrition and dietetics assessment of uncontrolled Type 2 Diabetes Mellitus. Anthropometry Weight: 92 kg Waist Circ: 105 cm Weight Hx: Jane reports a gradual weight gain of approximately 10 kg over the past 2 years, reaching her highest weight of 95 kg six months ago. She has been stable at 92 kg for the last 3 months with sporadic attempts at dietary changes. Nutrition Diagnosis 1. Altered nutrition-related laboratory values (elevated HbA1c, fasting glucose) related to excessive carbohydrate intake and inadequate physical activity as evidenced by HbA1c 8.5%, fasting blood glucose 9.8 mmol/L, and patient report of consuming sugary beverages daily and infrequent exercise. Nutrition Assessment Jane presents with poorly controlled Type 2 Diabetes Mellitus, exacerbated by a diet high in refined carbohydrates and sugars, limited intake of whole foods, and a sedentary lifestyle. Her current diet history reveals frequent consumption of processed foods, large portion sizes, and minimal fruit and vegetable intake. She expresses frustration with previous diet attempts and reports feeling overwhelmed by dietary guidelines. Psychosocial factors include a busy work schedule and limited time for meal preparation, often relying on takeaway meals. Her current understanding of carbohydrate counting and glycemic index is limited. There are no identified medical or nutritional causes beyond her current dietary and lifestyle patterns contributing to her uncontrolled diabetes. Recommendations / Intervention 1. Nutrition prescription and meal plan implemented to address uncontrolled Type 2 Diabetes Mellitus and high carbohydrate intake. a. Recommend a balanced macronutrient distribution with a focus on complex carbohydrates (45-50% of total energy), lean protein (20-25%), and healthy fats (25-30%). Prioritise low GI carbohydrates. Aim for 3 regular meals and 2 small snacks daily. b. Specific foods to include: whole grains (e.g., oats, brown rice, quinoa), lean proteins (e.g., chicken breast, fish, legumes), abundance of non-starchy vegetables (e.g., broccoli, spinach, bell peppers), small portions of fruit (e.g., berries, apple), and healthy fats (e.g., avocado, nuts, olive oil). Limit sugary drinks, refined cereals, and processed snacks. Advise portion control for starchy foods like bread and potatoes. 2. Nutrition education to provide guidance and enhance understanding of the cause and potential treatments underpinning their uncontrolled Type 2 Diabetes Mellitus. a. Discussion points included: basics of carbohydrate metabolism and its impact on blood glucose, understanding glycemic index, importance of fibre, label reading for carbohydrate content, and strategies for making healthier food choices when eating out. 3. Medical management and advice relating to clinical testing, supplements, medication and review with GP as it relates to Jane's presenting uncontrolled Type 2 Diabetes Mellitus. a. Recommend Jane continues regular monitoring of blood glucose levels. Suggest discussing with Dr. Jenkins potential medication adjustments if dietary changes alone are insufficient after a 3-month trial. Advise review of lipid profile and renal function in 6 months. 4. Nutrition-focussed counselling discussing nutrition and lifestyle-focussed strategies aimed at addressing unhelpful thinking styles or psychological underpinnings that may be contributing to barriers to change. a. Utilised motivational interviewing techniques to explore Jane's readiness for change and identify personal barriers. Discussed strategies for managing stress-related eating and setting realistic, achievable goals. Provided resources for healthy recipe ideas and local walking groups. Review in 4 weeks to assess progress with dietary changes, blood glucose trends, and address any challenges. Subsequent follow-up every 2-3 months until blood glucose targets are met and sustained. Kind Regards, [Clinician's Name] Accredited Practising Dietitian