ADA・AADE・AND合同ポジションステートメント：2型糖尿病自己管理教育・サポート

2型糖尿病の自己管理教育/サポート（DSME/S）は、一般にその価値が認められているが、現実には絶望的その機会は乏しい

ポジションステートメントで、そのエビデンスと戦略を提示


Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics
http://care.diabetesjournals.org/content/38/7/1372
http://care.diabetesjournals.org/content/early/2015/06/02/dc15-0730.full.pdf

Overview of medical nutritiontherapy (MNT)

MNT is an evidence-based application of the nutrition care process provided by the registered dietitian nutritionist. It includes an individualize d nutrition assessment, nutrition diagnosis, intervention and monitoring, and evaluation and is the legal de fi nition of nutrition counseling by a registered dietitian nutritionist practicing in the U.S. (8)


1. Characteristics of MNT reducing HbA 1c by 0.5 – 2% for type 2 diabetes:

• Series of three to four encounters with a registered dietitian nutritionist lasting from 45 to 90 min; the registered dietitian nutritionist should determine if additional encounters are needed
• Series of encounters should begin at diagnosis of diabetes or at first referral to a registered dietitian nutritionist for MNT for diabetes and should be completed within 3 – 6 months
• At least one follow-up encounter is recommended annually to reinforce lifestyle changes and to evaluate and monitor outcomes that indicate the need for changes in MNT or medication(s)

2. MNT provides nutrition assessment, nutrition diagnosis, and an intervention and management plan including the creation of individualized food plan and support for the following:

• Individualized modification of food plan/physical activity/medication dosing for improved postprandial control, hypoglycemia prevention, and overall glycemic improvement
• Individualized modification of carbohydrate, protein, fat, and sodium intake and guidance to achieve lipid and blood pressure goals
• Individualized weight management planning and coaching
• Education and support on additional topics to promote fl exibility in meal planning, food purchasing/preparation, recipe modification, and eating away from home
• Individualized modification of food plan for managing related complications and comorbidities such as celiac disease, gastroparesis, eating disorders/disordered eating, kidney disease, etc.

3. CMS reimburses for diabetes MNT when provided by a quali fi ed practitioner (i.e., registered dietitian nutritionist). Many other payers also provide reimbursement. MNT services are included on the ADA and AADE DSME/S referral forms. A separate MNT referral form is available from the Academy of Nutrition and Dietetics at http://www.eatrightpro.org/ ; /media/eatrightpro%20 fi les/about%20us/what%20is%20an%20rdn% 20and%20dtr/mnt_referral_form_15_jul_14.ashx. Note: The Academy of Nutrition and Dietetics recognizes the use of registered dietitian (RD) and registered dietitian nutritionist (RDN). RD and RDN can only be used by those credentialed by the Commission on Dietetic Registration