22 Personalised nutritional advice and sharing biomarkers with patients show improvements in metabolic health

<h3>Background</h3> In North West Wales a Cardiac Rehabilitation (CR) service review identified that 43% of patients had an HbA1c that was in the diabetes or prediabetes range. In 2018 only 42% of those with diabetes and 11% for those with prediabetes had an improvement in HbA1c upon completion of CR. <h3>Aim</h3> Our aim was to improve HbA1c results for more patients by changing from generic nutritional advice to a menu-based approach, personalised for each patient. <h3>Methods</h3> An analysis of HbA1c within the National Audit of CR data was undertaken on all patients referred to the service who completed CR and had an HbA1c recorded at both baseline and completion. In total 193 patients between 01/01/2018 and 31/12/2021 following a diagnosis of heart disease with diabetes and prediabetes were reviewed. A team of nurses and an exercise physiologist identified all patients who had diabetes or prediabetes. These patients were requested to complete a food diary. Their biomarkers were shared with patients and how changing what they eat can change their HbA1c, lipids, waist size, weight and reduce risk of developing other metabolic related conditions. Evidence-based resources via different formats for differing abilities, needs and goals were used. Various elements were discussed; ultra-processed food, sustainable changes, satiety, portion size, protein, development of insulin resistance, therapeutic carbohydrate restriction, alternative food choices, food timings and gut microbiome. <h3>Results</h3> In 2018 prior to the change to personalised nutritional advice 50% of patients with diabetes and 72% with prediabetes had an increase in HbA1c on completion of CR. Changes to advice commenced in 2019 and immediately improvements could be seen, by 2021 when the advice was scaled-up a significant (P=0.001) improvement was seen (table 1). <h3>Conclusion</h3> Changing to a personalised menu based approach has shown to improve diabetes and prediabetes associated biomarkers in a local CR service.