Summary
The dietitians in the paediatric diabetes team were keen to support all families to confidently manage their traditional cultural food. Both of these hospitals are based in central London with large population diversity. Often at diagnosis with diabetes families have requested support with carbohydrate counting for traditional foods. Therefore the dietitians were keen to produce a carbohydrate-counted recipe book using recipes provided by local families. This book is provided to all families within the service and at diagnosis with diabetes. The aim is to support families from all backgrounds with carbohydrate counting.
Innovation
The team identified a need for a locally relevant, carbohydrate-counted recipe book for families from various backgrounds. It was noticed that sometimes young people and their families avoided eating traditional foods through fear and lack of support with carbohydrate counting. The dietitians approached all families receiving diabetes care from the team and asked if they would like to share a traditional meal recipe, which would be carbohydrate counted and added to a cookbook. This cookbook would then be shared with all families under the care of the paediatric diabetes teams at the Evelina London (Guy’s and St. Thomas’ NHS Foundation Trust) and King’s College Hospital, London. All young people diagnosed with diabetes would be offered this cookbook, along with support to carbohydrate count any meals they were unsure about. This offer was always available, but it was hoped that this recipe book would reinforce it and ensure families were aware that the dietitians would help with calculations for food from any culture.
Equality, Diversity and Variation
During annual review appointments and reviews soon after diagnosis, it was noticed that many young people were avoiding traditional cultural foods as they were not listed in the carbohydrate counting resources. Often these were foods that the rest of the family continued to enjoy, or the young person enjoyed before diagnosis with diabetes. The families commented that they did not feel it was something that they wanted to bother the busy team with, or they thought that the team may not know the foods they were eating. This feedback resulted in the creation of the cookbook, with familiar foods and ingredients, to be distributed to all the families. The hope was that it would highlight to families the importance the diabetes team placed on supporting children and young people to celebrate their culture and to continue to enjoy these traditional family foods. The cookbook has received positive feedback from all families who have a copy. It was decided that the recipe book should be provided free of charge to all families with diabetes. However, a QR code was included on the book for recipients to make an optional contribution towards the supply of mobile phones for diabetes technology to families who could not afford them.
Results
Feedback from patients has all been positive. The dietitians enjoyed engaging with families in a different way to obtain the recipes and learn more about the foods the families were eating. It has also strengthened relationships between families and the team, particularly the dietitians. It has made conversations around food and eating more open with families and highlighted that the paediatric diabetes team is keen to adapt and support equality and diversity across the patient caseload. This project was not funded, but completed by the dietitians during work hours as part of regular discussions about meals and carbohydrate counting during appointments with families. They also spoke to families before or after appointments with the diabetes team, plus virtually via email. The dietitians analysed the recipes when they had time, or after work. The team had access to Canva software to formulate the recipe book so no additional funding was required. The diabetes and dietetic team used work time to complete the recipe book as the aim was to support families with their diabetes management and to create a useful future resource to continue to support young people and their families. The recipe book was shared with the paediatric diabetes specialist group of the British Dietetic Association (BDA) and has been shared as a national resource so all paediatric diabetes dietitian members can access and share it with young people and families.
User Feedback
Feedback was positive from families and the dietitians were nominated for an Excellence in Dietetics award from the lead paediatric dietitian.
Dissemination and Sustainability
This cookbook was compiled by the Evelina London and Kings College Hospital Paediatric diabetes teams. It was shared with the adult diabetes team at Guy’s and St. Thomas NHS Foundation Trust, as well as nationally via the paediatric diabetes subgroup of the BDA. Other services said that this project had prompted them to create a similar version for their local population. The team who created this cookbook are also keen to make a second edition, with further recipes, in the future. Some families commented that they would have liked to contribute a recipe but were unable to do so for the first volume.
