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

...Nutri...

...M: Nutrition Assessment The RDN...

Nutrition Intervention

Nutriti...

...ize Nutrition PrescriptionThe RDN s...

...Encourage Healthful Eating Plan for Appropriate...

...Reduced Energy Healthful Eating Plan for Overweig...

...dividualize Macronutrient CompositionTh...

...2: Carbohydrate Management StrategiesTh...

...ts with Type 1 or Type 2 Diabetes on...

...Adults with Type 2 Diabetes on MNT A...

...ge Fiber IntakeThe RDN should encou...

...: Advise on Glycemic Index and Glycemic LoadIf gly...

...ate on Substitution of Nutritive Sweeteners for O...

...se Against Excessive Intake of Nutritive Sweetener...

...n Intake of FDA-Approved Non-Nutritive...

...t Substitution of FDA-Approved Non...

...Educate on Protein Intake and Hypoglycemia in...

...Restriction for Diabetic Kidney Diseas...

...M: Type of Protein and DKDThe RDN...

...age Cardioprotective Eating PatternThe RDN sh...

...ge Individualized Reduction in Sodium...

...ise on Vitamin, Mineral and Herbal...

DM: Advise and Educate on Alcohol...

...Encourage Individualized Physical Activity...

...on Prevention and Treatment of Exercise-R...

...ion on Glucose MonitoringThe RDN shoul...

...oordination of CareThe RDN should...

Nutrition Monitoring and Evaluation

...N...

...nitor and Evaluate Effectiveness of MN...