Better Diabetes Prevention in Primary Care

Paradigm Shift in Public Health

As the discussion regarding the cost of healthcare and disease in this country continues to evolve, it is clear to me that Registered Dietitians will continue to play an important role.  While I believe in our role in preventive medicine (naturally!), it is nice to see more and more research provide the hard numbers and support from health institutions willing to place stake in that notion.

One large contributor to health care dollars spent in the US (let alone the impact to businesses from lost productivity) is diabetes care.  The Diabetes Prevention Program has been a coordinated clinical effort to study the impact of lifestyle changes, nutrition counseling, and weight loss in the role of preventing diabetes diagnosis.  The DPP utilized 27 clinical centers accross the country to study over 3000 participants.  Participants were overweight and had prediabetes, two strong predictors of diabetes diagnosis, and were separated into two groups: lifestyle intervention and medicinal intervention (850mg Glucophage BID).  

Nutrition and Lifestyle Intervention

The lifestyle intervention reduced incidence of Type II Diabetes diagnosis by 58% in this high-risk population, while usual intervention reduced incidence by only 14%.  See more about the research at the DPP link above or here!  Results like these beg the question... How do we turn that into common medical practice?

Well for one thing, expansion in Medicare and Medicaid reimbursement for preventive care practices and Medical Nutrition Therapy is helping to lead the way.  Private insurance companies often see the value in reimbursing visits to a Registered Dietitian so their range in reimbursement of RD services is much more liberal than Medicare/Medicaid.  [Reimbursement of services is something I could go on for many more blogs so I'll spare you right now - e-mail me with questions and we can continue the discussion!]

Growing the Role of Nutrition in Primary Care

The Primary Care Physician is the gatekeeper to specialty services and helps to coordinate the totality of your medical care, so find someone you trust with your health and feel free to have a conversation with them.  If you are struggling with certain chronic conditions and feel nutrition counseling can make a difference, ask about your options.  More and more PCPs truly understand the role of the Registered Dietitian in medicine and are making the appropriate referrals.

And to my fellow RDs: document, document document!  Make sure you're recording any and all useful data from beginning to end (BMI, weight, waist circumference, lipid panels, HbA1c, medication use, etc) with your clientele.  The only way we can and will continue to expand coverage for our services is by documenting the impact of nutrition counseling and lifestyle changes!