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

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.

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.

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.

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.