Developing a framework for carbohydrate awareness advice in type two diabetes

Type 2 Diabetes (T2DM) is a long-term condition in which dietary management is central, however there remains uncertainty about the most effective way to advise patients with T2DM about carbohydrate, even amongst Registered Dietitians (RDs). This research aimed to develop a framework for carbohydrate awareness advice using mixed methods research. Firstly, a meta-analysis found that evidence is lacking for a widespread carbohydrate restriction but restricting to below 130g per day offers short-term benefits for improving glycaemic control. The qualitative study involving interviews with people with T2DM and focus groups with RDs highlighted the importance of individualising advice for patients and identified helpful and unhelpful aspects of RD advice. RD reported practice varies, however they were able to describe carbohydrate awareness advice and outline key areas for professional development. Kleinman’s Explanatory Model and related concepts were applied to the findings from the two qualitative parts of the research and the systematic review. This allowed the construction of the Carbohydrate Awareness Advice Framework (CAAF) using the findings from this research and based on a strong theoretical foundation. The CAAF incorporates the findings from both the quantitative and qualitative research conducted for this thesis and should form the basis for an intervention in future clinical trials