2
Screening and Referral
➤ The primary goals of medical nutrition therapy (MNT) for adults
with type 1 and type 2 diabetes include glycemic control as well as
prevention and treatment of cardiovascular disease.
➤ Secondary goals include improvement of quality of life, optimization of
medication usage, and weight management.
DM: Screening for Type 2 Diabetes
➤ The registered dietitian nutritionist (RDN), in collaboration with other
members of the health care team, should ensure that all overweight or
obese adults at risk are screened for type 2 diabetes. Testing to assess
risk for future diabetes in asymptomatic people should be considered
in adults of any age who are overweight or obese (BMI ≥25 kg/m
2
or
≥23 kg/m
2
in Asian Americans) and who have one or more additional
risk factors for diabetes. (Fair, Imperative)
DM: Referral for MNT
➤ The RDN, in collaboration with other members of the health care team,
should ensure that all adults with type 1 diabetes and type 2 diabetes
are referred for MNT. Individuals who have diabetes should receive
individualized MNT to achieve treatment goals, preferably provided
by a RDN familiar with the components of diabetes MNT. (Strong,
Imperative)
DM: Initial Series of MNT Encounters
➤ The RDN should implement three to six MNT encounters during the first
six months and determine if additional MNT encounters are needed.
In studies reporting on the implementation of an initial series of RDN
encounters (3–11; total of 2–16 hours), MNT significantly lowered
HbA1c by 0.3%–2.0% in adults with type 2 diabetes and by 1.0%–1.9%
in adults with type 1 diabetes during the first six months, as well as
optimization of medication therapy and improved quality of life.
(Strong, Imperative)
DM: MNT Follow-Up Encounters
➤ The RDN should implement a minimum of one annual MNT follow-up
encounter. Studies longer than six months report that continued MNT
encounters resulted in maintenance and continued reductions of A1C
for ≤2 years in adults with type 2 diabetes, and for ≤6.5 years in adults
with type 1 diabetes. (Strong, Imperative)
