Nutrition therapy available for Medicare diabetes, kidney disease patients

After being diagnosed with diabetes last fall, food became a challenge for Mary Caya.

With a small amount of diet guidance, this 76-year-old winter visitor from Spokane, Wash., eliminated soda and candy from her diet. Her sweet tooth was suffering. But it didn't seem to help her blood sugar levels.

"I was watching my diet and I couldn't get it to go down where it should be," she said. "I had cut out sugars completely and I was quite surprised to see my blood count continue to go up."

So, with a referral from her doctor in Yuma, Caya met with Yuma Regional Medical Center Registered Dietitian Deborah Drumel to discuss disease management through a program called Medical Nutrition Therapy.

The two discussed a detailed plan for Caya.

"She showed me pictures of sizes of meat and it helped me to work on my portion sizes," Caya said.

And the counseling session came without any cost to Caya.

Medical Nutrition Therapy is a Medicare benefit that covers nutrition services for people with diabetes and nondialysis kidney disease.

With a physician's referral, Drumel can provide three hours of nutrition education, usually on three separate visits. She gives guidance on meal planning, food supplement intake, food preparation, recipe modifications, food label reading, dining out, physical activity and self-monitoring of blood sugar.

"We try to emphasize that this is not a diet," Drumel said. "We teach them that they need to manage their disease through a healthy approach. They set the goals depending on what their needs are."

The goal is to reduce the amount of medicine people are taking, decrease hospital admissions and shorten the length of hospital stays.

"It is intended to improve patient outcomes," Drumel said. "It can improve the quality of life for a person living with diabetes."

Patients may feel overwhelmed when they are first diagnosed with diabetes, Drumel said. They don't know what to eat or not eat.

"The whole issue with the carbohydrates is that many people, once they are first diagnosed with diabetes, don't understand what that means," she said. "They are not sure what they are supposed to do."

A month after she was diagnosed, Caya attended a class for diabetics. But it didn't provide the help she needed.

"I really wasn't given any one-on-one about what I should be eating," she said.

Through the Medical Nutrition Therapy, Caya was surprised to learn that she needed to limit her carbohydrate and fat intake.

"I wasn't being as cautious as I should have been with carbohydrates and fats," she said. "I thought it was mostly sugars."

The therapy isn't only for people who are newly diagnosed with diabetes or kidney disease.

Thomas Knowlton, a 79-year-old winter visitor from Eureka, Calif., was diagnosed with diabetes 20 years ago. But he still was having difficulty managing his blood sugar levels.

"I had uncontrollable diabetes. It was always too high or too low," he said. "So my doctor said I needed to meet with her and get this figured out."

In January, Knowlton met with Drumel to discuss a food plan. The one-on-one counseling was a good refresher course on nutrition do's and don'ts for diabetics.

"It brought to my attention the things that I had forgotten," Knowlton said. "She talked about what to eat and how to get my levels down. She went into quite a bit of detail. It has helped. There is no question about it."

A study done by The Lewin Group in 1998 showed that the therapy is associated with a substantial reduction in health care spending for inpatient and outpatient services for people with diabetes, cardiovascular disease and renal disease.

This national study, along with many others, contributed to the passage of the federal Benefits Improvement and Protection Act in December 2000, which created the reimbursement for dietitians offering Medical Nutrition Therapy for Medicare Part B recipients.

There is no shortage of people seeking this type of guidance.

Nationally, there are 18.2 million people living with diabetes, according to the American Diabetes Association. While an estimated 13 million have been diagnosed with diabetes, 5.2 million people are unaware that they have the disease.

Nearly 30 people have participated in the out-patient nutrition education program at YRMC since August 2003. Drumel is hoping more people take advantage of the Medicare benefit.

"It's still fairly new," she said. "A lot of people aren't aware of it, and often times nutritional education isn't covered through many types of insurance."

Both Caya and Knowlton recommended the program.

Caya said she appreciated the guidance. "I am a firm believer in following the diet."

--

Michelle Kann can be reached at mkann@yumasun.com or 539-6855.