Journal of Medical Nutrition and Nutraceuticals

EDITORIAL
Year
: 2012  |  Volume : 1  |  Issue : 1  |  Page : 3--4

Medical nutrition therapy for diabetes: The challenge in India


Sanjay Kalra1, Shilpa Joshi2, Manash Baruah3,  
1 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
2 Department of Consultant Dietician, Diet and Health Clinic, Mumbai, India
3 Department of Endocrinology, Excel Hospitals, Guwahati, Assam, India

Correspondence Address:
Sanjay Kalra
Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
India




How to cite this article:
Kalra S, Joshi S, Baruah M. Medical nutrition therapy for diabetes: The challenge in India.J Med Nutr Nutraceut 2012;1:3-4


How to cite this URL:
Kalra S, Joshi S, Baruah M. Medical nutrition therapy for diabetes: The challenge in India. J Med Nutr Nutraceut [serial online] 2012 [cited 2019 Dec 8 ];1:3-4
Available from: http://www.jmnn.org/text.asp?2012/1/1/3/94626


Full Text

Medical nutrition therapy (MNT), administered by a registered dietitian (RD) or nutrition professional, is a key component of diabetes management. [1] American Dietetic Association (ADA) clinical practice recommendations endorse MNT and lifestyle changes as alternatives and complements to pharmacotherapy. [1]

MNT is defined as "nutritional diagnostic, therapy, and counseling services for the purpose of disease management, which are furnished by a RD or nutrition professional." [2] The ADA defines the nutrition counseling component of MNT as "a supportive process to set priorities, a establish goals, and create individualized action plans which acknowledge and foster responsibility for self-care." [3]

The MNT provider performs a nutrition assessment, diagnosis, counseling, and suggest interventions to optimal diabetes management services according to best available current evidence, thereby contributing to optimal diabetes care.

MNT is not synonymous with diabetes self-management training (DSMT). DSMT is an education and training program that helps patients self-manage diabetes, whereas MNT consists of more individualized diagnosis, therapy, and counseling related to nutrition. [4]

MNT provide "more intensive nutrition counseling and a therapy regimen that relies heavily on follow-up and feedback to assist patients with changing their behavior (s) over." [4]

MNT is found to be effective for the treatment of both type 1 and type 2 diabetes, as well as the prevention of type 2 diabetes. The various studies related to MNT and have been reviewed by various authors. [5],[6]

If the science behind MNT is so robust, what is it that prevents this therapy from taking its rightful place in the managements of diabetes?

While many diabetes care professionals pay lip service to the importance of dietary management, few are ready to share responsibility for the patient with a dietician. This may reflect lack of teamwork in our professional training, or may be because there is a lack of understanding of the nuances and details of each other's profession. A perceived opinion about poor quality of practical training may act as a disincentive while involving dieticians in active patient care. Some physicians may feel that MNT is a "western" concept, which is not required in Oriental countries where use of home-made foods and traditional methods of cooking are ingrained in society.

Nothing can be further from the truth. MNT is an integral, and indispensable, part of diabetes management, in every setup. [1] Earlier, perhaps, it was possible for the individual physician to remain knowledgeable about every aspect of diabetes care, including nutrition, and treat patients on his or her own. In such a situation, nutrition and diet therapy was provided, albeit to a limited extent, by the doctor. In today's scenario, however, where scientific knowledge is expanding faster than ever, it is difficult for any health care professional to remain abreast of every current development in diabetology. The concepts of team-based care and patient centered approach have also become well-established, leading to a belated recognition of the fact that MNT, as defined in the earlier paragraphs, is central to effective diabetes management.

How can we, as health care professionals, enhance the acceptance of MNT in diabetes care? The challenge involves more than issue: the content, delivery, accessibility, and viability/sustainability of MNT.

Ample work has been done to promote the science of nutrition and dietetics in India. The transcultural nutrition algorithm for diabetes therapy is being customized to Indian needs, and should be published soon. Till then, we have available a consensus guidelines for healthy living and prevention of various metabolic disorders in Asian Indians published by the National Dietary Guidelines Consensus Group. [7]

This supplements similar position statements and guidelines published from other countries. [8],[9]

Apart from content, however, we need to work on delivery and acceptability,

The diabetes care professions should accept the dietician as an integral part of the diabetes care team, not as an ornamentary add-on. The nutritionists, at the same time, should ensure a thorough education in theoretical aspects, and extensive training in practical MNT, during the undergraduate and postgraduate curricula. All health care professionals involved in the diabetes care should be sensitized to the need for effective inter-departmental communication, which will lead to efficient team work and better patient health.

MNT provision is a challenge in developed countries, where third party payors, such as insurance or government, often do not reimburse MNT consultations. A greater challenge in encountered is countries such as India, where most patients pay from pocket for medical services, and may resist the idea of paying another medical professional. MNT as a separate discipline will have to be made financially viable, and thus, sustainable in the long run, by finding suitable payment methods, appropriate to each setting.

The JMNN will spearhead and support the campaign to give MNT to rightful place, not only in diabetes management, but also in other nutrition and lifestyle-related disorders.

References

1American Diabetes Association: Executive summary: Standards of medical care in diabetes-2009. Diabetes Care 2009;32:S6-12.
2U.S. Department of Health and Human Services: Final MNT regulations.CMS-1169-FC. Federal Register, 1 November 2001. 42 CFR Parts 405, 410, 411, 414, and 415.
3American Dietetic Association: Comparison of the American Dietetic Association (ADA) Nutrition Care Process for nutrition education services and the ADA Nutrition Care Process for medical nutrition therapy (MNT) services [article online]. Available from: http://www.eatright.org/advocacy/mnt. [Last Accessed 2009 Nov 6].
4Daly A, Michael P, Johnson EQ, Harrington CC, Patrick S, Bender T. Diabetes White Paper: Defining the delivery of nutrition services in Medicare medical nutrition therapy vs Medicare diabetes self-management training programs. J Am Diet Assoc 2009;109:528-39.
5Diabetes 1 and 2 Evidence Analysis Project American Dietetic Association Evidence Analysis Library Web site. Available from: https://www.adaevidencelibrary.com/topic.cfm?cat=1615. [Last Accessed 2009 Nov 6].
6Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence of medical nutrition therapy in diabetes management. Diabetes Care 2002;25:608-13.
7Misra A, Sharma R, Gulati S, Joshi SR, Sharma V, Ghafoorunissa, et al. Consensus dietary guidelines for healthy living and prevention of obesity, the metabolic syndrome, diabetes, and related disorders in Asian Indians. Diabetes Technol Ther 2011;13:683-94.
8Gougeon R, Aylward N, Nichol H, Quinn K, Whitham D. Nutrition Therapy. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Clinical Practice Guidelines; 2008. p. 540-5.
9American Diabetes Association. Nutrition Recommendation and Intervention for Diabetes. Diabetes Care 2008;31 Suppl 1:561-78.