It’s entirely normal to feel a bit of trepidation if you’re looking into medical nutrition therapy for diabetes. Since nutrition counseling is vital to successful diabetes management, breaking down the details can help you better understand what to expect.
Keep reading for more on the goals of medical nutrition therapy for diabetes, including how to get this crucial care covered by insurance.
What Is Medical Nutrition Therapy?
Medical nutrition therapy (MNT) is a form of treatment and nutrition care. It’s an application of the Nutrition Care Process (NCP), an approach with four standard steps:
1. Nutrition Assessment (and Reassessment)
2. Nutrition Diagnosis
3. Nutrition Intervention
4. Nutrition Monitoring and Evaluation
The NCP is used by a registered dietitian (RD) and supporting staff, such as diet technicians, to craft a personalized nutrition plan and determine what adjustments are needed to reach your goals. Adults with type 1 diabetes or type 2 diabetes mellitus can usually attend appointments alone. In contrast, children with diabetes are typically accompanied by an adult as they learn the basics of healthy eating with diabetes.
Regardless of the type of diabetes, MNT is an essential part of health care for diabetics and can improve their quality of life. It’s not a quick fix but a long-term strategy for improving health with potential benefits of reducing healthcare costs and medication reliance.
Medical Nutrition Therapy for Diabetes: Overview
Diving into the details of the nutrition care process for diabetes can help make medical nutrition therapy. Dietitians use the “ADIME” framework to chart your progress during medical nutrition therapy. ADIME stands for the four steps of the nutrition care process: assessment, diagnosis, intervention, and monitoring and evaluation.
To administer MNT, the American Diabetes Association recommends finding a dietitian with comprehensive knowledge and expertise in diabetes. These practitioners are distinguished by obtaining a specialist certification and a Certified Diabetes Care and Education Specialist (CDCES) designation. When seeking this type of specialist, you should see the name of your dietitian followed by the letters RD (or RDN) and CDCES.
Assessment
At the start of your nutrition journey, you’ll undergo an assessment, which is likely to include the following:
• Food history: Involves frequency of food intake, use of supplements, and relationship with food.
• Personal history: Lists health issues or pre-existing health issues you’re aware of, such as if you’ve struggled with prediabetes or have been diagnosed with a thyroid disease.
• Family history: Includes various health metrics that run in the family like diabetes, high cholesterol, and high blood pressure.
• Measurements: Lists anthropometrics such as height, weight, and weight changes.
• Tests and procedures: Identifies lab results (like hemoglobin A1C) collected by your doctor.
• Nutrition-Focused Physical Exam: A non-invasive physical examination that guides the dietitian to a diagnosis.
This step may include filling out forms and answering in-person questions, much like the intake process at a doctor’s office. Your dietitian may also ask you to keep a food journal or describe a typical day of eating for you, just to get a good feel for your current diet.
Diagnosis
During the the diagnosis step, the dietitian will use your assessment and the additional signs and symptoms you’ve described to decide on a nutrition diagnosis. This differs from a medical diagnosis in focusing primarily on a nutrition problem. For example, a dietitian won’t diagnose you with diabetes but may diagnose you with excessive carbohydrate intake.
In addition to diagnoses about intake, which specify if too little or too much nutrient is being consumed compared to estimated needs, diagnoses can also be given in the following areas:
• Clinical care: Identifies nutrition problems related to medical conditions (such as unintended weight loss due to diabetes).
• Behavior: Addresses limiting knowledge, attitudes, and beliefs affecting intake.
• Environment: Focus on factors affecting access to or safety of food.
Intervention
The intervention is the “game plan” step, where the dietitian will work with you to craft a plan of action. You’ll likely make goals, set a time for follow-up, and discuss the following aspects of your care plan:
• Food preferences
• Prescription medications
• Additional nutrition education
• Coordination of care with other health professionals
Common recommendations during this step include:
• Following a diabetic meal plan to improve glycemic control
• Education about carbohydrate counting
• Exercising for 30 minutes a day
• Weight loss for improved insulin sensitivity
Monitoring
Although monitoring and evaluation are traditionally combined into one step, they are distinct parts of the process that help to identify where you are at about your desired outcome. Monitoring typically involves:
• Reviewing the changes you’ve made since your last appointment.
• Revisiting measurements and lab tests.
•mDiscussing any new signs or symptoms that occur.
Your dietitian will work with you to establish key indicators, which can help you and your dietitian gauge whether the current intervention is working. A standard indicator established to monitor diabetes outcomes is whether a patient can get their blood sugar within the “normal” range.
Evaluation
Evaluation is the final step of the nutrition care process, and where the dietitian will determine how close you got to your goal or if progress has been made. Your RD may recommend altering your treatment plan if the current interventions aren’t sparking favorable changes, such as working with other members of your health care team to adjust diabetes medication.
Since diabetes is a lifelong condition, your nutrition journey will unlikely end with an evaluation. The American Diabetes Association and Academy for Nutrition and Dietetics recommend meeting with a dietitian three to six times for MNT in the first six months following a diagnosis and throughout the lifespan as needed.
Does Insurance Cover MNT for Diabetes?
Typically, diabetes is covered by Medicare for a diabetes diagnosis—specifically, Medicare Part B (medical insurance), and a doctor must refer you for these services. Medicaid coverage also varies from state to state.
In a clinical or hospital setting, you may need to take insurance questions to billing personnel. MNT nutrition diagnoses involve specific codes and claims you may have to submit to private practice practitioners who may work with insurance. Still, you may need to ask questions about how to get your care covered by insurance.
Because meeting with a dietitian several times following diagnosis is recommended, it’s worth finding out under what circumstances your insurance covers care.
Medical Nutrition Therapy for Diabetes: Final Takeaways
MNT for diabetes involves a partnership between a person with diabetes and a dietitian, where intentional steps are taken towards the optimal outcome. Although MNT involves standard nutrition care steps, it’s a process that can be personalized to your needs and readjusted as necessary. It encourages healthy eating long-term, which can be helpful since diabetes is a lifelong health consideration.
