MNT for Adults with Diabetes and Pre-Diabetes

Although the importance of medical nutrition therapy for adults with Type 1 and Type 2 diabetes has been well established, research continues to evaluate its effectiveness in managing complications, as well as costs, and has additionally focused on prevention. As a result, a number of evidence-based resources have been published highlighting the positive outcomes associated with MNT encounters for patients and clients who have or are at risk for diabetes and reinforce the role of registered dietitian nutritionists.

In 2018, the role of MNT and RDNs in the prevention and treatment of prediabetes and Type 2 diabetes was addressed in a Position Statement from the Academy of Nutrition and Dietetics. It stated that in addition to improving medical outcomes and quality of life for these patients and clients, that "MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes".

The cost-effectiveness of MNT delivered by RDNs in the management of diabetes, as well as lifestyle interventions for diabetes prevention, have also been recognized in several systematic reviews by the Academy's Evidence Analysis Library, in addition to other publications. The "strong evidence" base of MNT in diabetes care is described in the American Diabetes Association's updated recommendations for Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. This report also describes the role of the RDN as being uniquely qualified and the preferred member of the health care team to provide diabetes-focused MNT and briefly discusses the RDN's role, along with other providers, in adjusting glucose-lowering medications. "RDNs who possess advanced practice training and clinical expertise" are encouraged in this report to "take an active role in facilitating and maintaining organization-approved diabetes medication protocols".

A resource which can assist RDNs in assessing their competence in this area is the Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Diabetes Care. This document serves as a guide for self-evaluation; determining education and skills needed for advancing practice levels; and may be used by employer or regulatory agencies to determine competence for credentialed nutrition and dietetics practitioners. Case studies for RDNs in Diabetes Education and Care Plan Management that Includes Medication Adjustments and RDNs Delivering Telehealth Diabetes Care and Education-Related Services are also available from the Academy's Quality Management team.

The Standards of Medical Care in Diabetes, also known as the "Standards of Care", are released annually by the ADA and considered to be a comprehensive, evidence-based guide for practitioners. Since 2018, the online edition has evolved into a "living document", allowing for notable updates to be made throughout the year. This publication additionally acknowledges the "integral role" MNT plays in diabetes management and recommends that health care providers refer patients and clients to an RDN upon diagnosis and as needed.

Integrating MNT into the Nutrition Care Process is highly individualized and must account for patient and client food preferences, cultural observances and other medical diagnoses, as well as health literacy, and socioeconomic factors. RDNs as part of the health care team can utilize these resources when helping individuals with diabetes manage their symptoms and reduce the risk for further complications or delay their onset.

References:

• Early KB, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet. 2018;118:343-353.
• Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. May 2019, 42 (5) 731-754; DOI: 10.2337/dci19-0014.
• Davidson P, Ross T, Castor C. Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Diabetes Care. J Acad Nutr Diet. 2018;118(5):932-946.
• Standards of Medical Care in Diabetes – 2021. Diabetes Care. 2021 Jan; 44 (Supplement 1): S53-S72.
• American Diabetes Association. The Living Standards of Medical Care in Diabetes. Accessed June 14, 2021.