The pre-diabetes intervention package in (PIPI) primary care study: Can a practice nurse-led structured dietary approach prevent progression to diabetes?

Nurse Training Programme Practice nurses at the four intervention practices and community education nurses will undertake a 6-hour training course, which will include nutrition principles, dietary assessment, goal setting, the context within which nutrition advice is given and how to measure height, weight and waist circumference. The course will be both theoretical and practical. The dietary content of the course will be based on the 2004 Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes (EASD) evidence based guidelines for nutritional approaches to the treatment and prevention of diabetes mellitus. Dietary assessment and interpretation in the primary care setting, internal and external factors affecting food choices, culture, behaviour change and effective communication of dietary information will be included in the course. The course will be delivered by study investigators (public health physican, research dietitian, and research nurse/teacher) with input from a local dietitian (DS). A training manual will provide reference material, as well as research protocols. A 3-hour update course will be run at 6 months. This will be case study based, using a selection of cases seen by the intervention practice nurses to illustrate particular challenges encountered when providing study participant dietary consultations. A local dietitian will be readily available by email and phone to answer any questions from the practice nurses or discuss specific cases. The dietitian will also arrange monthly practice case review meetings with the practice nurses. Participant Dietary Advice Programme Participants will be asked to complete a brief dietary assessment, Starting the Conversation, a validated eight-item simplified food frequency instrument designed for use in primary care and health-promotion settings. Starting The Conversation (STC) was minimally modified, with permision, for the New Zealand context. The practice nurse will review the responses to the Starting the Conversation (STC) dietary assessment and ask additional dietary prompt questions to gain a better understanding of the participant’s dietary habits. The nurse will also enquire about additional contextual information such as the household membership and budget, who purchases the household foods and specific dietary requirements or choices such as vegetarianism, and take anthropometric measures (height, weight and waist circumference). A weight goal with the aim of a 5% weight loss over 6 months will be determined. The responses to the STC diet assessment, and the additional dietary and lifestyle questions will be used to inform three dietary goals negotiated with the participant, and the provision of individualised dietary advice tailored to their situation. This baseline appointment will take 30-45 minutes (including the study consent process). Fifteen minute follow-up sessions will be arranged 3 weeks later, then at 3 months and 6 months. Patient management system key messages The three individually tailored dietary goals determined between the practice nurse and participant will be incorporated into the general practice patient management systems. These messages will facilitate opportunistic targeted advice and guidance by GPs, thus reinforcing information provided at practice nurse dietary consultations. The goals/messges will be reviewed and updated accordingly at follow up practice nurse appointments.