The UK Diet and Diabetes Questionnaire: A new tool for assessing dietary habits.

Dr Clare England, Senior Research Associate and Specialist Diabetes Dietitian, in the Centre for Exercise, Nutrition and Health Sciences and the NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, discusses the challenges of providing individualised dietary advice for people with Type 2 diabetes and introduces a new, validated assessment tool, that may offer a solution.

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Diabetes UK estimates that over 3 million people in the UK are living with Type 2 diabetes, and a further 5 million are at high risk. Complications (for example, increased cardiovascular disease, kidney failure, blindness, foot ulcers and amputations) caused by poorly controlled Type 2 diabetes, costs the NHS an estimated at £7.0 billion.

There is an increasing choice of medication available for Type 2 diabetes which can help to reduce blood glucose, cholesterol and blood pressure, but a healthy diet, regular physical activity and good weight management underpin successful control.

There is strong evidence that regular dietary advice, provided by dietitians improves blood glucose control by improving diet. The National Institute for Health and Care Excellence (NICE) recommends that all people with Type 2 diabetes should receive individualised, on-going dietary advice from a health professional with expertise in nutrition, but many people aren’t getting this. Unfortunately, there are not enough specialist diabetes dietitians employed to provide this level of service, and there is considerable variation in provision. For example, the community dietetic service for people living in the north, inner city and east of Bristol is run by a different provider, on a different model, from that provided for people in South and West Bristol.

In the current environment the majority of people with Type 2 diabetes get their routine dietary advice from their GPs, practice nurses or community pharmacists. Some of these health professionals do an excellent job in providing good quality dietary advice but many say that feel they do not have the expertise to assess diets and give individualised advice. I have often heard people with Type 2 diabetes saying that the dietary advice they receive from their general practice is generic, and they struggle to see how to apply the advice they are given to make specific, beneficial changes to their own dietary habits.

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With this in mind, clinicians and academics at the Centre for Exercise, Nutrition and Health Sciences and School of Clinical Sciences felt there was a need for a brief dietary assessment tool that helps people assess their diets, and enables them to set dietary goals based on this assessment.

Over the last three years we have worked with dietitians, nurses, GPs and people with Type 2 diabetes to develop a brief dietary questionnaire to rapidly assess the dietary habits thought to be of most importance for people with Type 2 diabetes. The resulting questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), asks about consumption of higher energy foods and drinks, fruit, vegetables, oily fish, common higher fibre cereal foods and meal patterns. It takes roughly 10 minutes to complete and can be self-scored. We have just published the validation paper, which showed it to be reliable and compares as well with food diaries as other short dietary questionnaires. The UKDDQ is publically available for download and is equally applicable to people with a diagnosis of Type 2 diabetes, those at risk of Type 2 diabetes and the general population interested in healthy eating. Since the initial development, we have also worked with other researchers from the School of Sport, Exercise and Rehabilitation Science at the University of Birmingham, to check that the questionnaire is relevant to South Asian people (and made a few small changes to wording) and the UKDDQ was adopted by Birmingham South and Central Clinical Commissioning Group as the tool used for dietary assessment in the initial phase of the NHS Diabetes Prevention Programme.

We believe that using the UKDDQ in clinical practice would promote dietary change in people with, or at high risk of, Type 2 diabetes more effectively than the existing generic advice that people are currently hearing. We are planning further work to demonstrate this and would welcome interest from health professionals or people with Type 2 diabetes who would like to be involved in the project.

UKDDQ Project contact details:
Dr Clare England, clare.england@bristol.ac.uk
Centre for Exercise, Nutrition and Health Sciences / Bristol Nutrition BRU

‘Solidari-tea’ with Helen from The Archers

The Archers
Image of Ambridge courtesy of The Archers, bbc.co.uk

Dr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, School for Policy Studies, discusses how the current storyline in The Archers raises the question of what justice means when it comes to abuse?

Social media has once again been a-twitter with discussion about The Archers.

I wrote back in April about the domestic violence and coercive control storyline and how the producers had managed to shine a light on the often hidden aspects of abuse. As the story moves this week into the Courts, the media is once again gripped by the drama, with people posting their pictures of solidari-tea with the central character, Helen. The Mail Online even ran a story with Barristers discussing the fictional case .

As with the issue of coercive control more generally, the programme makers are tackling an important aspect of the experience of abuse, namely what is justice when it comes to abuse? This links directly to our current ESRC funded research which is looking at Justice, Inequalities, and Gender Based Violence. This research includes looking at police case files to examine the trajectory of different cases in relation to inequalities and different types of abuse. In addition, we are currently recruiting victims/survivors to speak to us about their experiences of different types of gendered abuse and justice. This includes adult men and women who may have experienced forced marriage, sexual violence, sexual abuse, ‘honor-based’ crimes, and domestic violence and abuse. This project looks beyond the narrow focus of justice in terms of the police and courts, although this is not excluded, and includes people who, for a range of reasons, haven’t reported to the police or have used alternative forms of justice.

This project, like the current Archers storyline, is intended to illustrate what justice and injustice look like, and how formal and informal responses to abuse can highlight the wider responsibilities of society to address the issue and take a stand.

Whatever the outcome in The Archers, the everyday reality for many victims/survivors is that the very idea of ‘justice’ is more complex than a court outcome. Domestic abuse doesn’t just impact on the victims/survivors, but the perpetrators themselves (research shows they have higher rates of depression and anxiety), friends and family members, as well as wider communities. This is all too real for those who have themselves or know someone who has experienced abuse.

The Archers storyline sheds a light on the wider impacts of abuse as the manipulation of the perpetrator affects a whole raft of relationships within families and communities. Irrespective of whether Helen gets ‘formal’ justice in the coming weeks, the damage to those relationships will continue for many years to come. Some would question therefore whether we can ever get ‘justice’ when so many harms go unanswered.

We look forward to following the fictional court case as well as the on-going struggles which the main characters and the Ambridge community as a whole face as they come to terms with the impact of abuse. We once again commend the writers for staying true to the victim’s story and not turning away.

Anyone interested in taking part in our justice research can register an interest, or contact us to discuss in more detail, at:

Website: http://tinyurl.com/hj5oda5
Email: sps-justiceproject@bristol.ac.uk
Telephone: 07807 799967.