Diabetes Medical Nutrition Therapy

Publication Date: May 19, 2017

Screening and Referral

Screening and Referral

  • The primary goals of medical nutrition therapy (MNT) for adults with type 1 and type 2 diabetes include glycemic control as well as prevention and treatment of cardiovascular disease.
  • Secondary goals include improvement of quality of life, optimization of medication usage, and weight management.


DM: Screening for Type 2 Diabetes

The registered dietitian nutritionist (RDN), in collaboration with other members of the health care team, should ensure that all overweight or obese adults at risk are screened for type 2 diabetes. Testing to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. (Fair, Imperative)
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DM: Referral for MNT

The RDN, in collaboration with other members of the health care team, should ensure that all adults with type 1 diabetes and type 2 diabetes are referred for MNT. Individuals who have diabetes should receive individualized MNT to achieve treatment goals, preferably provided by a RDN familiar with the components of diabetes MNT. (Strong, Imperative)
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DM: Initial Series of MNT Encounters

The RDN should implement three to six MNT encounters during the first six months and determine if additional MNT encounters are needed. In studies reporting on the implementation of an initial series of RDN encounters (3–11; total of 2–16 hours), MNT significantly lowered HbA1c by 0.3%–2.0% in adults with type 2 diabetes and by 1.0%–1.9% in adults with type 1 diabetes during the first six months, as well as optimization of medication therapy and improved quality of life. (Strong, Imperative)
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DM: MNT Follow-Up Encounters

The RDN should implement a minimum of one annual MNT follow-up encounter. Studies longer than six months report that continued MNT encounters resulted in maintenance and continued reductions of A1C for ≤2 years in adults with type 2 diabetes, and for ≤6.5 years in adults with type 1 diabetes. (Strong, Imperative)
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Nutrition Assessment

...rition Assessme...

...n Assessment The RDN should assess the follo...


Nutrition Intervention

...on Intervention...

...ualize Nutrition PrescriptionThe RDN should indivi...


...ourage Healthful Eating Plan for Appropriate-Weig...


DM: Encourage Reduced Energy Healthful Eat...


...dividualize Macronutrient CompositionThe...


...Carbohydrate Management StrategiesThe RDN...


...: Educate Adults with Type 1 or Type 2 Diabetes...


...Educate Adults with Type 2 Diabetes on MNT Alone o...


...ge Fiber IntakeThe RDN should encourage a...


...n Glycemic Index and Glycemic LoadIf g...


...cate on Substitution of Nutritive Sweeteners...


...Advise Against Excessive Intake of...


...ntake of FDA-Approved Non-Nutritive Sweeten...


...bout Substitution of FDA-Approved No...


DM: Educate on Protein Intake and H...


...ein Restriction for Diabetic Kidne...


...Protein and DKDThe RDN should advise a...


...urage Cardioprotective Eating PatternThe RDN shoul...


...ndividualized Reduction in Sodium IntakeTh...


...tamin, Mineral and Herbal Supplement...


...nd Educate on Alcohol ConsumptionThe RDN...


...M: Encourage Individualized Physical...


...M: Educate on Prevention and Treatment of Exerci...


DM: Education on Glucose MonitoringThe...


...rdination of CareThe RDN should implement MNT and...


Nutrition Monitoring and Evaluation

...Monitoring and Evaluatio...

...DM: Monitor and Evaluate Effectivenes...