Pastors et al9 reviewed randomized controlled trials, observational studies, and meta-analyses of studies of medical nutrition therapy in patients with diabetes. The authors found that medical nutrition therapy was successful in obtaining better glycemic control, if dietitians follow clinical guidelines in managing patients with diabetes. In order for patients to benefit from medical nutrition therapy, they should be seen and followed by a dietitian. Patients should be seen 6 weeks after their initial consultation to determine their progress and make changes if needed. After 6 weeks to 3 months, the changes in the hemoglobin A1C level should be notable, and adjustments to diet and/or medication can be made at that time.9

Findings from these studies suggest strong evidence for using medical nutrition therapy to achieve better glycemic control. A registered dietitian with experience in diabetes management is needed to counsel patients on the appropriate dietary changes. Dietitians must have access to patients’ laboratory data in order to track their progress, and they must collaborate with providers to make changes to medications when necessary. Dietitian interventions that follow clinical practice guidelines enable patients to achieve better metabolic control. This saves them the cost of medication therapy and prevents the early pancreatic burnout that leads to insulin-dependent diabetes. These studies show that medical nutrition therapy administered by a registered dietitian is beneficial for patients with non-insulin-dependent diabetes. 



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Recommendations for providers

  • Do not manage diabetes with medications alone.
  • Refer patient to registered dietitian with knowledge of diabetes. Allow dietician access to patient’s labs and medications.
  • Medical nutrition therapy should be initiated for patients classified in the pre-diabetic range to prevent diabetes
  • Insurance covers dietary counseling for diabetes management in those diagnosed with diabetes
  • Monitor hemoglobin A1C throughout dietary changes. As nutrition improves, less medication may be needed to control blood glucose
  • To provide the patient with incentive to see a registered dietician, suggest cost-savings and discontinuation of some diabetic medications as potential benefits.

Implications for practice


The findings of this review can inform providers on the benefits of using medical nutrition therapy to manage patients with non-insulin-dependent diabetes. Collaborating with a registered dietitian who has experience in diabetes management can allow patients to achieve better glycemic control, thus reducing the medications taken and saving costs. Future studies are necessary to determine if medical nutrition therapy can delay or prevent pre-diabetes from developing into type 2 diabetes. 

Jill Norris White, RN, BSN, CMSRN, is a certified medical surgical registered nurse working in a digestive disease unit at the Medical University of South Carolina (MUSC). She currently is a student in MUSC’s Doctor of Nursing Practice Program and will graduate in May 2016.

References


  1. Hu FB, Liu S, van Dam RM. Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia. 2001;44(7):805-817.

  2. Johnson W, Shaya FT, Winston R, et al. Diabetes control through an educational intervention. Ethn Dis. 2014:24(2):182-188. 

  3. The cost of diabetes. American Diabetes Association Web site. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. Edited June 22, 2015. 

  4. Bantle JP, Wylie-Rosett J, Albright AL, et al; American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008:31 Suppl 1:S61-S78. 

  5. Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002;25(3):608-613.

  6. Franz F, Splett P, Monk A, et al. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc. 1995;95(9):1018-1024.

  7. Franz MJ, Monk A, Barry B, et al. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus. J Am Diet Assoc. 1995;95(9):1009-1017.

  8. Johnson EQ, Valera S. Medical nutrition therapy in non-insulin-dependent diabetes mellitus improves clinical outcome. J Am Diet Assoc. 1995;95(6):700-701.

  9. Pastors JG, Franz MJ, Warshaw H, Daly A, Arnold MS. How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc. 2003;103(7):827-831.



All electronic documents accessed March 9, 2016.