ADA issues report about individualizing diet for people with diabetes

When a person is diagnosed with diabetes, the first question they often ask a health professional is “What can I eat?” A new consensus report from the American Diabetes Association (ADA) aims to get all health professionals who provide care for people with diabetes on the same page about individualizing nutrition therapy for adults with diabetes and prediabetes.

“Though it might simplify messaging, a “one-size-fits-all” eating plan is not evident for the prevention or management of diabetes, and it is an unrealistic expectation given the broad spectrum of people affected by diabetes and prediabetes, their cultural backgrounds, personal preferences, co-occurring conditions (often referred to as comorbidities), and socioeconomic settings in which they live,” stated the report, published in ADA’s Diabetes Care in May.

Although this message of an individualized approach to nutrition may be obvious to pharmacists who are certified diabetes educators (CDEs), the report serves as a reminder that people with diabetes need to be referred to diabetes self-management education and support (DSME/S), an educational opportunity that qualified pharmacists are able to provide people with diabetes. However, when a pharmacy has an accredited DSME/S program and doesn’t have a registered dietitian (RD) onsite who can offer people with diabetes appropriate medical nutrition therapy (MNT), pharmacists should know how to refer them to an RD.

“These guidelines help me [do that],” said Katherine Koffer, PharmD, CDE, assistant professor of clinical pharmacy at the University of the Sciences in Philadelphia. “I can now say to the patient, ‘There’s been some changes in the guidelines, and I’d like you to consider seeing a registered dietician to review your eating plan.’”

When Susan Cornell, PharmD, CDE, FAPhA, FAADE, worked in community pharmacy, she was proud of the access and resources her grocery store pharmacy could provide people who needed DSME/S, which helps people with diabetes build the skills, knowledge, and behaviors needed to self-manage diabetes.

As a DSME/S pharmacy, Cornell’s practice site was closer for many to get to than the other DSME/S program in town, and it didn’t have a waiting list. The pharmacy also had an RD on staff who provided MNT and was able to bill for it. (Reimbursement for pharmacists’ DSME/S counseling varies by state. For instance, when certain coverage criteria are met, Medicare Part B will reimburse pharmacists for delivering DSME/S.)

While Cornell acknowledged that not every DSME/S pharmacy will have an RD onsite, she said people can be referred to one.

“My message to community pharmacy is to get a list of two to three registered dieticians who are focused on diabetes that you can refer people to,” said Cornell, who is an associate professor of pharmacy practice at Midwestern University Chicago College of Pharmacy.

At diabeteseducator.org, individuals can “find an educator” by zip code. DSME/S programs can be accredited either through ADA or the American Association of Diabetes Educators (AADE), and accreditation helps people with diabetes find programs.

“If the pharmacy doesn’t offer DSME/S, they should know where they can refer the person,” said Cornell.

The importance of a DSME/S referral is also stressed in the report.

According to a 2015 position statement from ADA and AADE, only 6.8% of individuals with newly diagnosed type 2 diabetes who had private health insurance participated in DSME/S within 12 months of diagnosis, and only 4% of Medicare participants received DSME/S or MNT.

ADA said that MNT, which is provided by an RD, is fundamental in a diabetes management plan, and the need for it should be reassessed frequently.

For the full article, please visit www.pharmacytoday.org for the July 2019 issue of Pharmacy Today.