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Issue 95 Item 12 Does MNT (Medical Nutrition Therapy) Work?

Study shows a drop in A1c for newly diagnosed Type 1’s of 1% and for newly diagnosed Type 2 of 2% In a econometric study of 12,308 patients with diabetes, Sheils et al. measured the potential savings from MNT and estimated the net cost to Medicare of covering these services for Medicare enrollees. Differences in health care utilization levels of individuals with diabetes, cardiovascular disease, and renal disease were estimated for hospital discharges, physician visits, and outpatient visits for those who did and did not receive MNT. MNT was associated with a reduction in utilization of hospital services of 9.5% for patients with diabetes. Also, utilization of physician services declined by 23.5% for individuals with diabetes who received MNT. The authors concluded that after an initial period of implementation, coverage for MNT can result in a net reduction in health services utilization and costs. In individuals aged 55 years and older, the savings will actually exceed the cost of providing the MNT benefit.

Franz et al. evaluated the cost-effectiveness of implementing MNT in type 2 diabetes. The cost of unit of change in fasting plasma glucose (1 mg/dl) from entry to 6 months was determined. The intensive nutrition intervention had a cost-effectiveness ratio of $4.20 compared with usual nutrition care with a cost-effectiveness ratio of $5.32. These findings suggest that individualized nutrition interventions can be delivered by dietitians with a reasonable investment of resources and that the cost-effectiveness is enhanced when dietitians are engaged in active decision-making regarding intervention based on patient needs.

Evidence-based research strongly suggests that MNT provided by a registered dietitian who is experienced in the management of diabetes is clinically effective. Randomized controlled nutrition therapy outcome studies have documented decreases in HbA1c of 1% in newly diagnosed type 1 diabetes, 2% in newly diagnosed type 2 diabetes, and 1% in type 2 diabetes with an average duration of 4 years. MNT should be considered as monotherapy, along with physical activity, in the initial treatment of type 2 diabetes, provided the person has a fasting plasma glucose <200 mg/dl. Individuals with type 2 diabetes who cannot achieve optimal control with MNT and whose disease may be progressing due to ß-cell failure should be prescribed blood glucose-lowering medication, along with additional encouragement to achieve goals of MNT and physical activity. As R. Holman (Oxford, U.K.) stated in a discussion of the UKPDS findings, "if the real problem is the progressive decrease in ß-cell function, it is our duty to explain this and not castigate these individuals because they have failed to diet".

Despite the fact that the effective promotion of healthy eating and physical activity is challenging in our society, it is now well documented that MNT does make a difference.

Diabetes Care 25:608-613, 2002