Abstract
This thesis discusses the history of Diabetes Mellitus (DM) which has been recognised since antiquity. The role of the diet in the management of DM is discussed in the light of the development of scientific dietetics made possible by the chemical analysis of food. Both the development of the profession of the State Registered Dietitian (SRD) and the workload of the dietetic department at Bedford Hospital is described over a period of 5 years. It was noted that 35% to 49% of all new referrals for dietetic advice had a diagnosis of DM. A survey of diet sheets supplied for patients with a diagnosis of DM, apart from forbidding sugar, showed a total lack of consistency. Nor did the dietary advice meet the recommendations of the scientific literature with respect to appropriate dietary management or even guidelines on 'healthy eating'. A study of the referral pattern of patients for dietetic advice over a period of 3 years showed that a number of them were never seen by a SRD. Examination of the medical records of 100 patients with a diagnosis DM, showed that, apart from a benefit to weight reduction, the advice from a SRD did not significantly assist in the reduction of complications. Difficulties in the diagnosis of DM were discussed. It was found that 18 patients with a recorded diagnosis of insulin dependant DM had insulin requiring DM. These patients were older (p< 0.001) and had spent more days in hospital (p< 0.001) than others with DM. Case histories of 6 people with DM showed great variations in the impact of the advice from a SRD with some individuals requiring little or no advice. Recommendations for ways in which SRDs could examine and improve their practice are made, including that for a greater unity in advice on diet for DM, such as is provided in diet sheets.