Nutrition Assessment and Glycemic Control in Wound Care

DMCA.com Protection Status
Blog Category: 

By Mary Ellen Posthauer, RDN, CD, LD, FAND

After reading Laurie Swezey's blog, "Diabetic Foot - Risk Factors and Prevention", I decided to weigh in on the issue of poor glycemic control. Teamwork is an essential ingredient since achieving glycemic control is a challenge for all clinicians including the registered dietitian (RD).

A key component in achieving glycemic control is referral of the client, who is a qualifying beneficiary under Medicare Part B, to the dietitian for Medical Nutrition Therapy (MNT) and/or to a Diabetes Self Management Training (DSMT) program. Medicare regulations defines the program requirements that qualified providers must follow for MNT and DSMT program compliance. Medicare MNT involves comprehensive clinical care provided by licensed/certified (as applicable) RDs and nutritional professionals. DSMT programs, which must be accredited as meeting quality standards by a Center for Medicare and Medicaid Services (CMS) approved national accreditation organization, include a nutrition education component based on the National Standards for Diabetes Self-Management Education.

CMS regulations allow for RDs to provide the nutrition education component of an accredited DSMT program, as well as MNT to qualifying Medicare Part B beneficiaries. CMS acknowledges that the provision of MNT and DSMT may be more medically effective for some beneficiaries than receiving just one of the benefits. RDs providing services to individuals with diabetes and/or services under the DSMT program typically have advanced practice for diabetes care or are certified diabetes educators.

Providing MNT services begins with a comprehensive assessment including data collection on the client's Food and Nutrition History:

  • Food/Nutrient Intake: composition of the meals and snacks during the course of a day.
  • Medication/Herbal Supplements: checking all medications, in particular those over-the-counter medications or herbal supplements that could be problematic.
  • Knowledge/Beliefs: understanding the client's feelings/emotions on nutrition concepts related to diabetes and the readiness to adjust their nutrition related behaviors.
  • Behaviors: includes client activities and actions that influence the ability to achieve nutrition goals.
  • Factors Affecting Access to Food: includes understanding the factors that affect the individual's availability to secure a sufficient quantity of safe, nourishing food.
  • Physical Activity/Function: includes their cognitive and physical ability to engage in specific tasks; shopping, meal preparation, physical activity, medication delivery.
  • Nutrition-Related Client Centered Measures: consists of the client's perception of their nutrition intervention and its impact on life plus the understanding of their diet's contribution to their health.

Additional assessment data consists of anthropometric measurements (height, weight and weight history), biochemical data plus a nutrition-focused physical exam. A nutrition-focused physical exam is an evaluation of the body systems such as subcutaneous fat wasting, oral health, ability to chew/swallow, etc. Client history is an important piece of the assessment process that encompasses general information for the client such as age, role in the family, race/ethnicity, family or medical history that may have a nutritional impact, in addition to any social history, housing situation or support systems.

Once all of the above data has been evaluated the RD will write a nutrition diagnosis, not a medical diagnosis. The client and the RD will develop an individualized intervention plan and together they will monitor and evaluate this plan in an effort to achieve a successful outcome such as glycemic control, to be part of a comprehensive wound prevention strategy.

Next month we will follow a client thought this process and discuss methods for achieving glycemic control.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the Academy of Nutrition and Dietetics’s Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Recommended for You

  • Nutrition and protein intake
    December 2nd, 2015

    By Bruce E. Ruben MD

    A day doesn't go by that I'm not bombarded with information on the newest diet, the latest exercise trend or the fastest way to get in shape. My email inbox opens with message subjects like "click here to drop 10 pounds fast" or "how to get a Kardashian body...

  • hydration
    August 4th, 2015

    By Mary Ellen Posthauer RDN, CD, LD, FAND

    The "dogs days of summer" with temperatures approaching 90 and above plus high humidity levels remind us of the importance of hydration. While you are focusing on quenching your thirst, don't forget about your wound care clients.

  • Nutrition and medicine
    December 1st, 2016

    By Mary Ellen Posthauer, RDN, CD, LD, FAND

    The World Union Wound Healing Society (WUWHS) held their 2016 meeting in historic Florence, Italy in September. The initial meeting of the WUWHS was held in Australia in 2000 and is convened every four years. I have had the unique...

Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use.