Nutrition and Oral Medicine (Nutrition and Health)

Chapter 11 / Diabetes Mellitus 197Table 7Goals of Medical Nutrition TherapyGoals for all persons with diabetes• Attain and maintain desirable metabolic outcomes Normal blood glucose values Lipid profile consistent with risk reduction for macrovascular complications Blood pressure levels associated with reduced risk for vascular disease• Prevent and treat associated chronic complications of diabetes Modify nutrient intake and lifestyle to prevent obesity, dyslipidemia, cardiovascular disease,hypertension, nephropathy• Improve health through healthy food choices and physical activity• Address individual nutritional needs considering personal and cultural preferences and lifestyleGoals for specific situations• In youth with T1DM, provide adequate energy for normal growth and development, integrateinsulin regimens into usual eating and physical activity habits• In youth with T2DM, facilitate changes in eating and physical activity habits that reduce insulinresistance and improve metabolic status• In women who are pregnant and lactating, provide adequate energy and nutrients needed for optimaloutcomes• In older adults, provide for the nutritional and psychological needs of an aging individual• In individuals treated with insulin or insulin secretagogues, provide self-management education fortreatment (and prevention) of hypoglycemia, acute illnesses, and exercise-related blood glucoseproblems• In people at risk for diabetes, decrease risk via encouraging physical activity and promotion of foodchoices that facilitate moderate weight loss or at least prevent weight gainAdapted from ref. 74.that addresses current diet intake, eating patterns, lifestyle, metabolic status and control,readiness to change, goal-setting, diet instruction, and monitoring of response to therapy.Individuals at increased risk should be referred to an RD for MNT. The high-risk patientpopulation includes persons at risk for oral problems because of poor glycemic controland those with diabetes who face dental (oral) procedures that will affect their functionalability to eat. Examples include individuals undergoing oral surgical procedures inwhich eating ability will be compromised for several days or longer (dental implants,extensive periodontal surgery, multiple extractions), those getting full dentures, or thosegetting reconstructive surgery.Medicare reimbursement for MNT for individuals with diabetes supports referrals toan RD by dental professionals for individuals with diabetes. In most states, MNT by anRD with several follow-up visits is a benefit covered by all third-party payers andMedicaid. In addition to referring patients as appropriate to an RD, the oral healthprofessional should reinforce the need to adhere to the diabetic diet, integrate oralhygiene into daily routines, and modify diet consistencies as needed to manage oralconditions and surgeries.