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Medical Nutritional Therapy: An Essential Pillar for Diabetes Management
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    By: Coralis Alsina, RD, LND, CWCM, DEPR
    Medical Nutrition Center President and Nutritionist
    MCS Collaborator


    Practice guidelines from the Academy of Nutrition and Dietetics recommend that dietitian nutritionists coordinate three (3) to six (6) Medical Nutritional Therapy (MNT) visits for adults with diabetes. These interventions have resulted in a significant reduction in HbA1c in adults with type 2 diabetes, with a range of 0.3% to 2.0%, and a range of 1.0% to 1.9% for those with type 1 diabetes. Thanks to this series of visits, maintenance for an optimal glycemic level for up to six (6) years has been observed in longitudinal studies. However, beyond HbA1c control, what is the dietitian nutritionist’s impact on patient care and health outcomes?

    A study published in the Academy of Nutrition and Dietetics journal systematically evaluated clinical studies that measured the effectiveness of MNT on health markers associated with patients with type 2 diabetes:

    • Significant reductions in LDL cholesterol, ranging from 8 to 22 mg/dL
    • Significant increases in HDL cholesterol, ranging from 2.4 to 6 mg/dL
    • Significant reductions in triglycerides, ranging from 15 to 153 mg/dL
    • Significant decreases in systolic and diastolic blood pressure, ranging from 3.2 to 9 mm Hg for systolic, and 2.5 to 5.3 mm Hg for diastolic

    The researchers also published results on the effect of MNT on drug use and quality of life. MNT resulted in a reduction in dose and/or number of prescribed hypoglycemic drugs. In people with type 2 diabetes, researchers reported improvements in health perception, increased knowledge and motivation, and reduced emotional stress. In those with type 1 diabetes, significant improvements in quality of life, treatment satisfaction, and psychological well-being were also reported.

    MNT for diabetes management comprises a series of topics covered at each visit. These interventions have been evaluated in clinical trials to measure effectiveness, are indicated in the Nutritional Practice Guidelines published by the Academy of Nutrition and Dietetics, and must be conducted by the dietitian nutritionist. For a nutritionist’s individualized care and/or private practice, while there is no exact order to cover these activities, the nutritionist is familiar with the patient, and can structure the diabetes education to fit that person’s needs.

    1. Carbohydrate management: The dietitian nutritionist will establish the amount of carbohydrates and other macronutrients for the nutritional plan. This intervention also favors education on insulin administration versus carbohydrate intake in patients.
    2. Hypoglycemia prevention: Topics such as the effect of protein in meals and snacks, effects of alcohol, physical activity, and adherence to drugs for glucose regulation are clarified. Education is incorporated to understand the data offered by glucometers and/or sensors for continuous glucose monitoring, as well as the impact of certain foods on glucose levels.
    3. Time for education: Family members and caregivers are included in visits to facilitate teamwork. Intervention time can range from around 15 to 60 minutes per visit.

    Approximately 57.44% of patients with diabetes have experienced hypoglycemia at some point. Similarly, some patients have multiple health conditions and do not necessarily benefit from a standard eating protocol provided during primary care. At the time of a diabetes diagnosis, a myriad of questions arise about what and how much to eat, particularly in patients who are physically active and need the right advice to manage their condition without sacrificing their nutritional requirements. Therefore, it’s essential that when diagnosing a patient with type 1 or type 2 diabetes, the primary care physician or specialist refers them to the dietitian nutritionist for MNT. Medical Nutritional Therapy improves clinical outcomes, increases the success of diabetes treatment, and is a key component to the proper management of the condition.


    References:

    1. Franz, M. J., MacLeod, J., Evert, A., Brown, C., Gradwell, E., Handu, D., Reppert, A., & Robinson, M. (2017). Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. Journal of the Academy of Nutrition and Dietetics, 117(10), 1659–1679. https://doi.org/10.1016/j.jand.2017.03.022
    2. Samya, V., Shriraam, V., Jasmine, A., Akila, G. V., Anitha Rani, M., Durai, V., Gayathri, T., & Mahadevan, S. (2019). Prevalence of Hypoglycemia Among Patients With Type 2 Diabetes Mellitus in a Rural Health Center in South India. Journal of primary care & community health, 10, 2150132719880638. https://doi.org/10.1177/2150132719880638
    3. Wei, F. X., & Qi, X. P. (2018). Nutrition therapy for type 2 diabetes: confirmed efficacy on individualized management. Diabetes, metabolic syndrome and obesity : targets and therapy, 11, 479–481. https://doi.org/10.2147/DMSO.S179432