Screening and Referral

Nutrition Assessment

Nutrition Intervention

Nutrition Monitoring and Evaluation

Document Overview

Design and created by Guideline Central in participation with the Academy of Nutrition and Dietetics.

Diabetes in Adults: Medical Nutrition Therapy

Academy of Nutrition and Dietetics

Publication Date: May 18, 2017

Page Last Updated: May 5, 2026

DM: Nutrition Assessment

The RDN should assess the following in adults with type 1 diabetes and type 2 diabetes, to formulate the nutrition care plan: Biochemical data, medical tests and medication usage:
- Type of diabetes
- Glycemic control (target glucose and A1C levels are noted in the annual American Diabetes Association Standards of Medical Care in Diabetes)
- Lipid profiles
- Blood pressure
- Stage of chronic kidney disease
- Use of glucose-and lipid-lowering medications, anti-hypertensive medications, prescription and other over-the-counter medications, herbal supplements and complementary or alternative medications.
Nutrition-focused physical findings:
- Height, weight, BMI and waist circumference
- Injection sites
- Relative importance of weight management.
Client history:
- General health and demographic information
- Social history
- Cultural preferences
- Health literacy and numeracy
- Education and occupation
- Knowledge, beliefs, attitudes, motivation, readiness to change, self-efficacy and willingness and ability to make behavioral changes
- Physical activity
- Patient or family nutrition-related medical and health history
- Other medical or surgical treatments
- Previous nutrition care services and MNT recommendations.
Food and nutrition-related history:
- Food, beverage and nutrient intake including energy intake, serving sizes, meal-snack patterns, carbohydrate, fiber, types and amounts of fat, protein, micronutrient intake and alcohol intake
- Experience with food, previous and current food and nutrition history, eating environment, access to healthy foods and eating out.
Assessment of the patient’s psychological and social situation should be included as an ongoing part of the medical management of diabetes, which may include, but is not limited to, attitudes about the illness, expectations for medical management and outcomes, affect and mood, general and diabetes-related quality of life, resources (financial, social and emotional), and psychiatric history, as well as addressing common co-morbid conditions that may complicate diabetes management.

( Fair, Imperative )

Grading Table

Statement	Definition
Strong	Benefits clearly exceed the harms (or harms clearly exceed the benefits for a negative recommendation) The quality of the supporting evidence is excellent/good (grade I or II)
Fair	Benefits exceed the harms (or harms clearly exceed the benefits for a negative recommendation) Quality of evidence is not as strong (grade II or III)
Weak	Quality of evidence that exists is suspect Or that well-done studies (grade I, II or III) show little clear advantage to one approach versus another
Consensus	Expert opinion (grade IV) supports the guideline recommendation
Insufficient Evidence	Both a lack of pertinent evidence (grade V) and/or an unclear balance between benefits and harms
Imperative	Imperative statements are broadly applicable to the target population and do not impose restraints on their pertinence. Imperative recommendations may include terms such as “should” or “may” and do not contain conditional text that would limit their applicability to specified circumstances.
Conditional	Conditional statements clearly define a specific situation or population. Conditional recommendations are often presented in an if/then format, such that if CONDITION then ACTION(S) because REASON(S). Fulfillment of the condition triggers one or more guideline-specific actions.

Document Overview

Document Title: Type 1 and Type 2 Diabetes in Adults: Medical Nutrition Therapy

Authoring Society: Academy of Nutrition and Dietetics

Document Publication Date: May 18, 2017

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: No

Full Text Guideline: www.jandonline.org/article/S2212-2672(17)30332-5/fulltext

Source Citation: Franz MJ, MacLeod J, Evert A, Brown C, Gradwell E, Handu D, Reppert A, Robinson M. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. J Acad Nutr Diet. 2017 Oct;117(10):1659-1679. doi: 10.1016/j.jand.2017.03.022. Epub 2017 May 19. PMID: 28533169.

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Management

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus

D003922 - Diabetes Mellitus, Type 1

D000066888 - Diet, Food, and Nutrition

D044623 - Nutrition Therapy

D003924 - Diabetes Mellitus, Type 2

D003920 - Diabetes Mellitus

D003922 - Diabetes Mellitus, Type 1

D000066888 - Diet, Food, and Nutrition

D044623 - Nutrition Therapy

D003924 - Diabetes Mellitus, Type 2

Keywords: diabetes, diabetes mellitus, nutrition

Target Patient Population: Type 1 and Type 2 Diabetes in Adults

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Dietician/Nutritionist, Nurse, Nurse Practitioner, Physician, Physician Assistant

Diabetes in Adults: Medical Nutrition Therapy

Screening and Referral

DM: Screening for Type 2 Diabetes

DM: Referral for MNT

DM: Initial Series of MNT Encounters

DM: MNT Follow-Up Encounters

Nutrition Assessment

DM: Nutrition Assessment

Nutrition Intervention

DM: Individualize Nutrition Prescription

DM: Encourage Healthful Eating Plan for Appropriate-Weight Adults with Diabetes

DM: Encourage Reduced Energy Healthful Eating Plan for Overweight or Obese Adults with Diabetes

DM: Individualize Macronutrient Composition

DM Type 1 and 2: Carbohydrate Management Strategies

DM: Educate Adults with Type 1 or Type 2 Diabetes on Fixed Insulin Doses or Adults with Type 2 Diabetes on Insulin Secretagogues

DM: Educate Adults with Type 2 Diabetes on MNT Alone or Non-Insulin Secretagogues

DM: Encourage Fiber Intake

DM: Advise on Glycemic Index and Glycemic Load

DM: Educate on Substitution of Nutritive Sweeteners for Other Carbohydrates

DM: Advise Against Excessive Intake of Nutritive Sweeteners

DM: Educate on Intake of FDA-Approved Non-Nutritive Sweeteners

DM: Educate About Substitution of FDA-Approved Non-Nutritive Sweeteners

DM: Educate on Protein Intake and Hypoglycemia in Adults with Diabetes

DM: No Protein Restriction for Diabetic Kidney Disease (DKD)

DM: Type of Protein and DKD

DM: Encourage Cardioprotective Eating Pattern

DM: Encourage Individualized Reduction in Sodium Intake

DM: Advise on Vitamin, Mineral and Herbal Supplementation

DM: Advise and Educate on Alcohol Consumption

DM: Encourage Individualized Physical Activity Plan

DM: Educate on Prevention and Treatment of Exercise-Related Hypoglycemia

DM: Education on Glucose Monitoring

DM: Coordination of Care

Nutrition Monitoring and Evaluation

DM: Monitor and Evaluate Effectiveness of MNT

Grading Table

Document Overview

Document Scope, Criteria, and Use Cases