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Diabetic care in general practice: Author's reply

EDITOR,-The findings of Pringle and colleagues that access to a dietitian improves metabolic control' confirms others' work.2 Presumably this is why doctors want dietitians to advise people with diabetes34 and why the British Diabetic Association recommends that diabetics should see a dietitian at diagnosis and yearly thereafter." It is illogical for Pringle and colleagues to conclude that it would be more appropriate for dietitians to train practice nurses than to see patients. How much and what sort of training would be needed to achieve similarly good results? Can nurses be released for training? Do dietitians have the time to train? What happens to all the patients who are not being advised because the dietitians and nurses are involved in training courses? What training in teaching do dietitians need to train others, and do they have these skills? None of these issues were covered in the study. Nor was the cost of providing services. A senior 1 dietitian's salary is comparable to that of an F grade nurse and slightly less than that of a nurse on grade G. People with diabetes should get dietary advice from a dietitian. This gives a better metabolic outcome and represents excellent value for money. It adds up to the best service to patients, which is what it's all about.