title: Factors associated with consulting a dietitian for diabetes management: a cross-sectional study.
abstract: BACKGROUND
  Type 2 Diabetes (T2D) has reached epidemic levels in the Middle East region. Despite evidence that it improves health outcomes and saves health costs, dietary counseling for T2D remains grossly under-investigated in this region. The aim of this study was to assess the frequency and determinants of use of dietary counseling services by T2D patients in Lebanon and recommend corrective measures that may guide the planning, organization and delivery of care for chronic diseases in general and diabetes care in particular.
  
  
  METHODS
  A non-experimental cross-sectional design was utilized to survey outpatients with T2D in two major health centers in Lebanon. Patients diagnosed with T2D were invited to complete a questionnaire consisting of five sections: socio-demographic characteristics, disease attributes, patients' perceptions regarding T2D management, practice of lifestyle modifications, and referral by a physician to a dietitian. The outcome of interest was the use of dietary counseling services by T2D patients at least once since their diagnosis. Descriptive statistics and logistic regression analyses were used to evaluate the frequency and determinants of dietary counseling services utilization.
  
  
  RESULTS
  A total of 332 T2D patients completed the questionnaire (response rate 94.6%). Although 75% of study participants believed that dietitians can assist them in changing their dietary habits, only 38% had consulted with a dietitian. Among study participants, only 34% were referred to a dietitian by their physician. The main determinants of the use of dietary counseling services were referral by a physician (OR: 112.25; 95% CI = 42.74-294.84), the presence of outpatient social or private health insurance (OR: 5.86; 95% CI = 2.40-14.25) and the belief that a dietitian can assist in changing dietary habits (OR: 3.74; 95% CI = 1.33-10.54).
  
  
  CONCLUSIONS
  The findings of this study show suboptimal use of dietary counseling services by T2D patients in Lebanon. Key determinants were physicians' referral, financial support for outpatient care, and patients' belief in the usefulness of dietary counseling. Suggested interventions entail enhancing the planning and organization of care through inter-professional collaboration between physicians and dietitians; promoting public financing for high quality outpatient care that includes dietary counseling; and promoting the value of dietary counseling and improving the public image of dietitians.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alameddine
authors.forename: Lara
authors.initials: L
authors.lastname: Nasreddine
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
authors.forename: Yara
authors.initials: Y
authors.lastname: Mourad
authors.forename: Hikma
authors.initials: H
authors.lastname: Shoaib
authors.forename: Dana
authors.initials: D
authors.lastname: Mousa
authors.affiliation: Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon. fn14@aub.edu.lb.
authors.forename: Farah
authors.initials: F
authors.lastname: Naja
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000628:therapy; D005260:Female; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D064686:Nutritionists / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires