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Diabetes Standards of Care & Clinical Practice Resources

Medical Nutrition Therapy

Medical Nutrition Therapy (MNT) includes individualized assessment, intervention, monitoring, and follow-up of nutrition interventions specific to the management and treatment of diabetes, other diseases, and other health conditions. Delivered by a registered dietitian (RD) who uses nationally recognized Academy of Nutrition and Dietetics protocols, MNT involves intensive nutrition counseling and therapy that relies heavily on follow-up and feedback to change behavior over a period of time.

There is good evidence that MNT is effective at any time in the disease process, but it appears to have its greatest effect in lowering A1C at initial diagnosis. MNT also has been shown to be cost-effective and is a Medicare-reimbursable service when provided by a RD.

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Clinical Practice Recommendations

Recommendations for Medical Nutrition Therapy

  • Refer every person with diabetes/prediabetes to a registered dietitian (RD), whenever possible, for individualized MNT at diagnosis and as needed thereafter to achieve treatment goals.
  • Lifestyle counseling by all clinicians needs to include these core messages: implement dietary modifications that reduce intakes of calories, saturated and trans fatty acids, and sodium, and increase physical activity to improve glycemia, dyslipidemia, and blood pressure.
  • Evaluate patients for food insecurity and accessibility and affordability of nutritious foods available to them; refer them as needed to food resources available in the community.

A major factor that prevents many people with diabetes from adhering to MNT approaches is food insecurity. Nearly half of all households below the poverty level in the U.S. are food insecure, including AI/AN, who are overrepresented among low-income families. Food insecurity means these families are at risk of going hungry because of an inability to find or afford adequate food. In terms of diabetes, food insecurity creates a major barrier to managing and preventing diabetes effectively, and contributes to health disparities and disease burden.