Diabetes Medical Nutrition Therapy

Publication Date: May 18, 2017

Screening and Referral

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/m2 or ≥23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. (Fair, Imperative)
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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)
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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)
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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)
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Nutrition Assessment

Nutrition Assess...

...Nutrition Assessment The RDN should...

Nutrition Intervention

...ition Intervention...

...ize Nutrition PrescriptionThe RDN should...

...Healthful Eating Plan for Appropria...

...courage Reduced Energy Healthful Eating Pla...

...lize Macronutrient CompositionThe RDN,...

...2: Carbohydrate Management StrategiesThe RD...

...M: Educate Adults with Type 1 or Type 2 Diabetes...

...ults with Type 2 Diabetes on MNT Alone...

...ge Fiber IntakeThe RDN should encourag...

...n Glycemic Index and Glycemic LoadIf glycemic...

...: Educate on Substitution of Nutritive Sweetener...

...Against Excessive Intake of Nutrit...

...on Intake of FDA-Approved Non-Nutritive S...

...out Substitution of FDA-Approved Non-Nutrit...

...: Educate on Protein Intake and Hypoglycemia in...

...rotein Restriction for Diabetic Kidney...

...ein and DKDThe RDN should advise adu...

...rage Cardioprotective Eating PatternThe RDN sho...

...ge Individualized Reduction in Sodium IntakeThe RD...

...Advise on Vitamin, Mineral and Herbal S...

...vise and Educate on Alcohol Consumption...

...courage Individualized Physical Activ...

...Educate on Prevention and Treatment...

...Glucose MonitoringThe RDN should ens...

...nation of CareThe RDN should implement MNT and...

Nutrition Monitoring and Evaluation

...Monitoring and Evaluatio...

...or and Evaluate Effectiveness of MNT...