More than one in ten adults worldwide now lives with diabetes, and roughly half of them receive no medication to control their blood glucose at all. Yet even within well-resourced health systems, two of the most basic pillars of diabetes care—personalised nutrition therapy and professional foot assessment—are routinely missed. A new national survey of Australian health professionals, published in BMC Endocrine Disorders, has mapped precisely where the system breaks down, and the findings paint a picture of a care pathway undermined not by a lack of clinical guidelines but by conflicting advice, cost barriers, and a widespread underappreciation of what allied health services actually deliver.
The study, led by Roberta Asher, Rachael M. Taylor and colleagues at the University of Newcastle and Hunter Medical Research Institute, took the form of a cross-sectional online survey. A total of 208 health professionals completed it, spanning the disciplines most directly involved in day-to-day diabetes management: dietitians made up 48 percent of respondents, credentialled diabetes educators 34 percent, general practitioners 11 percent, and practice nurses 7 percent. Participants were asked to report both the facilitators that help them deliver medical nutrition therapy, often abbreviated to MNT, and podiatry care for adults with diabetes, and the barriers that get in the way. The quantitative responses were summarised with descriptive statistics, while the free-text answers were sorted into themes using inductive content analysis, a technique that lets categories emerge from the data rather than being imposed in advance.
Medical nutrition therapy is the formal term for individualised dietary counselling delivered by a qualified dietitian, and clinical guidelines around the world position it as a cornerstone of diabetes management. The survey found grounds for cautious optimism here: the most frequently reported facilitator, cited by more than 70 percent of respondents in every discipline, related to health professionals’ own nutrition knowledge for diabetes management. In other words, the clinicians who refer and deliver this care feel confident in the underlying science of diet and blood glucose. That confidence, however, sits alongside a striking problem identified by the dietitians themselves: adults with diabetes were receiving conflicting nutrition advice from other health professionals, which directly undermined patients’ willingness to take up formal nutrition therapy. When a patient hears one message from their dietitian and a different one from another member of their care team, the result is confusion, distrust, and disengagement.
The barriers reported by the non-dietitian disciplines tell the other half of the story. Health professionals outside dietetics identified patient reluctance to consult a dietitian as a major obstacle, alongside a lack of understanding of the importance of nutrition within their own ranks, and limited availability of dietetic services in the first place. This is a layered problem. Patients are hesitant to book appointments they may not fully understand; some referring clinicians do not emphasise nutrition strongly enough; and even when both parties are willing, the service may simply not exist nearby. Each layer compounds the others, which helps explain why Australian allied health services, including dietetics and podiatry, remain underused by adults with diabetes despite being explicitly recommended in clinical guidelines.
On the podiatry side of the ledger, the survey found a genuine structural success. Foot assessment was performed by many health professionals—more than 65 percent in each discipline—as part of an annual cycle of care, the structured review schedule that Australian diabetes care is built around. This matters because diabetic foot disease is one of the most feared complications of the condition: peripheral neuropathy dulls sensation, peripheral arterial disease impairs healing, and the combination can turn a minor ulcer into an infection that ends in amputation. Regular professional foot checks are the single most effective way to catch problems early, and the fact that this assessment is embedded in routine annual care appears to be working as intended. The system, in this one respect, is doing what the guidelines ask of it.
But the podiatry findings also exposed two stubborn barriers. The first was appointment cost, reported by between 48 and 53 percent of respondents in each discipline. Private podiatry in Australia is often only partially subsidised, and for patients managing the considerable ongoing expenses of diabetes—glucose monitoring, medications, transport—out-of-pocket fees for foot care can feel like a discretionary luxury rather than essential preventive medicine. The second barrier was patients’ lack of understanding of why a podiatry foot assessment matters for diabetes management, reported across a remarkably wide range of 48 to 93 percent depending on discipline. That spread is itself informative: general practitioners and practice nurses, who see the consequences of neglected feet in their practices, appear far more aware of the stakes than some other professional groups, or perhaps more attuned to their patients’ misconceptions.
The technical architecture of the study deserves attention because it shapes how the results should be read. As a cross-sectional survey, it captures a snapshot of professional opinion at a single point in time rather than tracking outcomes in patients, so it measures perceived barriers and facilitators, not hard clinical endpoints such as amputation rates or glycaemic control. The sample of 208 is respectable for a national professional survey but is dominated by dietitians and diabetes educators, with only 11 percent general practitioners, which means the perspectives of the medical workforce that does most of the referring are represented more thinly. The inductive content analysis of qualitative responses is a strength, allowing unexpected themes such as conflicting nutrition advice to surface, but the themes are a posteriori categories and would benefit from confirmation in future studies. The study received ethics approval from the Hunter New England Human Research Ethics Committee and was conducted in accordance with the Declaration of Helsinki, and the authors declared no competing interests.
Placed in global context, the findings carry weight well beyond Australia. With at least 10 percent of adults worldwide living with diabetes and half of those cases untreated with glucose-lowering medication, the burden falls disproportionately on health systems that can least afford complications. Nutrition therapy and foot screening are among the most cost-effective interventions available: better dietary management can delay or prevent the need for medication escalation, and early detection of foot pathology can avert amputations that cost orders of magnitude more than the screening visit itself. If even a wealthy system with universal health insurance infrastructure struggles to deliver these services reliably, the barriers identified here—cost, awareness, workforce availability, and contradictory advice—are likely to be magnified elsewhere.
The authors’ conclusion is correspondingly practical: increasing health professionals’ knowledge of general nutrition advice, as well as the role and value of dietetic and podiatry services, will be important for improving diabetes care. That recommendation cuts in two directions. Referring clinicians need enough nutrition literacy to give consistent, evidence-based messages that reinforce rather than contradict the dietitian’s plan, and patients need clearer communication about why an annual foot check or a session with a dietitian is not an optional extra but a core component of staying well with diabetes. The funding for the work came from a Hunter Medical Research Institute Colonial Diabetes Alliance Program Grant, with the funder having no role in the study’s design, analysis, or reporting.
What makes this survey genuinely useful is that it converts a vague sense that allied health is underused into a specific, actionable checklist. Embedding foot assessment in the annual cycle of care has demonstrably worked; the same logic suggests that embedding consistent nutrition messaging across the whole care team, subsidising podiatry access for high-risk patients, and educating both clinicians and patients about the value of these services could close the remaining gaps. Diabetes is a disease managed largely between clinic visits, in kitchens and bathrooms and on daily walks, and the professionals surveyed here have identified exactly which levers need pulling to support that daily self-management. The evidence now exists; the task is turning survey findings into referral pathways, funding decisions, and conversations that patients actually hear.
Subject of Research: Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes
Article Title: Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes: a national survey of health professionals
Article References: Asher, R., Burrows, T., Acharya, S., Parsons, M., Southwell, A., Joseph, M., Redford, M., Chan, K., Ross-Evans, S., Tehan, P. E., Martin, E., Stanford, J., Clarke, E., Hure, A., Donnelly, H., Collins, C. E., & Taylor, R. M. (2026). Barriers and facilitators to delivering medical nutrition therapy and podiatry care for adults with diabetes: a national survey of health professionals. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02604-4
Image Credits: AI Generated
DOI: 10.1186/s12902-026-02604-4
Keywords: diabetes, medical nutrition therapy, podiatry, dietitians, health professionals, national survey, barriers, facilitators, foot assessment, diabetes educators, allied health, diabetes management
News Source: Ophelia Keating. (October 13, 2026). Why Diabetes Patients Miss Out on Dietitians and Foot Care: New Survey Reveals the Gaps. Scienmag.
