Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a “nutrition-based treatment provided by a registered dietitian nutritionist.” It includes “a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes.”57
Studies have documented an association between MNT delivered by a registered dietitian and A1c decreases for people with type 1 diabetes (0.3%–1%)58,59 and type 2 diabetes (0.5%–2%).60,61,62,63 According to the 2017 Standards of Medical Care in Diabetes, “Each person with diabetes should be actively engaged in education, self-management, and treatment planning with his or her health care team, including the collaborative development of an individualized eating plan.”64,65
DSMT and MNT are separate but complementary services. Although relying on distinct techniques, DSMT and MNT together are more effective than either service would be if offered alone. Studies report improved outcomes with combined DSMT and MNT. Although DSMT and MNT practitioners can provide follow-up in the same year, the two types of services require separate referrals.66
Note: Medicare will not reimburse DSMT and MNT if provided on the same day.67
DSMT is provided by diabetes educators who:
- Are licensed or nationally registered health care professionals.
- Provide overall guidance related to all aspects of diabetes.
- Increase the person with diabetes’ knowledge and skill about the disease.
- Promote self-care behaviors for effective self-management and glycemic control.
MNT is provided by registered dietitians or nutritional professionals. MNT:
- Is an intensive, focused, food prescription nutrition therapy service.
- Involves in-depth individualized nutrition assessment.
- Relies heavily on follow-up to provide repeated reinforcement to aid with behavior change.
- Establishes goals, a care plan, and interventions.
- Plans for follow-up over multiple visits to assist with behavioral and lifestyle changes relative to each individual’s nutrition problems and medical condition or disease(s).66
Additional resources for MNT are below:
American Diabetes Association Standards of Medical Care in Diabetes – 2017external icon:
These standards outline recommendations for diagnosis and management of diabetes, including MNT.
Medicare Billing for DSMT and MNT Services pdf icon[PDF – 3 MB]external icon:
This link is to a PowerPoint presentation from the American Diabetes Association.
Academy of Nutrition and Dietetics—MNT vs Nutrition Educationexternal icon:
This tool compares the Academy of Nutrition and Dietetics (AND) Nutrition Care Process for Nutrition Education Services and the AND Nutrition Care Process for Medical Nutrition Therapy (MNT) Services.
Food prescriptions are part of a broader concept of social prescribing. Pioneered in the United Kingdom and growing in popularity in the United States and Canada, social prescriptions are issued by health-care practitioners to provide patients with non-pharmaceutical interventions, including dance classes, walking groups, volunteer work, art lessons and, of course, fresh fruits and vegetables.