VA Policy Change Increases Impact of RDNs on Interprofessional Diabetes Care Teams

A U.S. Department of Veterans Affairs policy change will allow registered dietitian nutritionists (RDNs) to provide additional diabetes care including medical device training and support for continuous glucose monitors (CGMs) as part of an expanded scope of practice. The Academy of Nutrition and Dietetics has advocated for RDNs to have an expanded scope of practice for diabetes management and the use of technology and applauds this change which increases timely access to care and may reduce patient harm.

The Veterans Health Administration (VHA) RDN scope was modified following expansion of CGM device availability to more than 386,000 veterans using insulin and an internal review of how the VHA could positively impact expanded CGM.

The change was announced in a July 25, 2024, memorandum released by the Department of Veterans’ Affairs Assistant Under Secretary for Health for Clinical Services/Chief Medical Officer, Erica Scavella, MD, FACP, FACHE.

The memorandum noted that there are approximately 1.7 million veterans with diabetes, with 35% requiring daily insulin. Dr. Scavella stated that the role of RDNs as part of the interdisciplinary health care team is to “assist in basic, formal and reinforcement CGM education, provide diabetes medical nutrition therapy with emphasis on impact of food choices and glycemic excursions, and review hypoglycemia risk and nutrition intervention.”

To facilitate RDNs’ competency with CGMs and technology, the VHA will offer learning opportunities, assist with questions and answers, and reinforce basic medical nutrition therapy practice.

Expansion of the RDNs’ scope by the VHA sets the stage for other payers and health systems to consider similar policy changes. In addition, information gained from the VHA model will be valuable in future advocacy efforts by the Academy and others in the diabetes community.