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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
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