Although nutritional advice and counseling are an important part of diabetes care, current Hungarian health care regulations make it available only in the secondary (specialist) care. Authors planned and implemented a self-financed nutritional counseling in primary care setting. For 67 of 108 diagnosed diabetic patients of a primary care practice in Budapest, a free of charge educational service was offered. The 47 patients (45 type 2 and 2 type 1) who accepted the invitation were educated in two consecutive group sessions. Only 24 of them were ready to take part in three further individual consultations. Fasting blood glucose and glycated hemoglobin were measured before and after the sessions and 1 year later. Comparison was made between genders (31 men, 16 women) and patients who took part in the group and the individual nutritional counseling, respectively. Patients with a higher educational level, males and persons with shorter duration of diabetes were more likely to participate in the consultation. All glycemic parameters improved after counseling in both groups, but this was significant only in men and for the group consultation. After 1 year, a further improvement was seen in women and in patients of the individually counseled group. In turn, fasting blood glucose and glycated hemoglobin concentrations of men and group-consulted patients increased again, reaching almost the baseline level before consultations. Nutritional counseling in the primary care offers more comfort and help for diabetics but requires changes in insurance regulation, and reimbursement system together with increase in resources.
2010 S. Karger AG, Basel.