Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

Weight Loss/Maintenance
Even a moderate loss of 5-10% of overall body weight in patients with diabetes will result in
improvement of blood glucose, blood pressure and lipids profile.
Nearly 80% of patients who lose weight will gradually regain it if they are not supported by a
weight maintenance program. The keys to a successful weight maintenance program are patient
motivation and team support from health care providers. Effective management of overweight
and obesity can be delivered by a variety of healthcare providers including primary care providers,
registered dietitians, nutritionists, exercise physiologists, nurses, and psychologists.
Achieving and maintaining an appropriate body weight requires daily effort, good dietary/
nutritional behaviors and adequate physical activity. Combined management approaches (diet,
exercise and behavior modification) are likely to produce better results than any single approach.
Healthcare providers should encourage patients to consult their health plan for weight loss/
maintenance programs that may be covered by their policy.
Medical Nutrition Therapy (MNT) 9,36,40,41
Medical Nutrition Therapy (MNT) services involve a nutritional assessment, specific diet planning,
and counseling services to prevent or treat an illness or medical condition. MNT counseling
services are typically provided by a registered dietitian (RD) focusing on behavior and lifestyle
changes with the goal of addressing nutrition problems and associated medical conditions,
such as diabetes. MNT goals for the treatment of diabetes focus on interventions to maintain
blood glucose, lipids, and blood pressure within a normal range in order to prevent or slow the
rate of development of the chronic complications of the disease. In addition, MNT can be useful
in helping patients with diabetes to achieve and maintain a healthy body weight. During each
counseling session, the RD works with patients to assess individual needs, determine goals,
develop a care plan, and monitor overall progress towards treatment goals.
Coverage for and access to MNT services vary by health insurance program or carrier. Patients
should consult with their health insurance evidence of coverage booklet or call their health plan
regarding coverage for MNT services. Medicare currently covers MNT services for people with
diabetes or renal disease as a means of helping to manage the condition covering. Medicare
covers 3 hours of one-on-one counseling the first year, and 2 hours each subsequent year.
Beneficiaries may be able to receive more hours of treatment with a physician’s referral if the
condition, course of treatment or diagnosis changes. Physicians must prescribe MNT services for
Medicare recipients and renew the referral annually as necessary. 41
For a list of CPT codes for MNT, please go to chapter 7, page 139.
CMA FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011 57
Comprehensive
management of
type 2 diabetes