Limited Awareness of Benefit

For people with diabetes or kidney disease nutrition education should be a key part of their treatment. 

Unfortunately, a recent report from Kaiser Health News discovered that very few Medicare patients with diabetes or kidney disease are aware their health coverage includes dietary counseling. 

If a patient wants more than Medicare initially covers, their doctor can appeal for additional dietary counseling.

This benefit was approved by Congress in 2002.

“Under the Affordable Care Act (ACA), the counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011,” explains AARP.

Better Diets would improve Health and Lower Costs

If dietary counseling were used more frequently by patients, not only would they see improvements in their health, but Medicare would significantly reduce future costs from complications of diabetes and kidney disease.

The report states that fewer than 5 percent of Medicare patients with diabetes or kidney disease actually use their 10 to 12 hours of diabetes self-management training either. This covers nutrition, exercise, how to monitor your blood sugar, understanding your medications, and reducing your risk of diabetes complications.

Another contributing problem may be that many physicians don’t realize their patients are eligible for benefits like nutritional counseling, and doctors don’t often have enough time with each patient to do more than write a prescription and assess bloodwork.

Diet Discussions are Often Avoided

Many patients are reluctant to seek counseling because they are overwhelmed by the idea of sharing their current eating habits, being expected to give up the foods they love, and likely having to learn new ways of cooking and preparing food.

“It’s easier to prescribe a medication than it is to discuss the importance of nutrition and get patients to meet with a registered dietitian,” said Holly Kramer, a Chicago nephrologist and president of the National Kidney Foundation.

“I don’t understand how we have this burgeoning obesity and diabetes epidemic and we are not using dietitians in our clinics for all these patients, yet we are paying for all these things that mediate from the disease process such as arthritis, dialysis, and amputations,” added Kramer.

Power of Diet

Other research continues to demonstrate the tremendous impact that lifestyle changes can have on a person’s overall diabetes health. Without sufficient patient education and support, however, these studies don’t make much of a difference.

Another issue is that even if patients did make use of the available dietary counseling, it’s only for a few hours, which isn’t realistic considering the length of time it takes to truly help a person assess their current nutrition and begin improving and changing those habits.

“It’s better than nothing, but in my mind is not sufficient,” said Jennifer Weis, a registered dietitian in Philadelphia. 

Other Supporting Research 

Recent research published in Diabetologia, the journal of the European Association for the Study of Diabetes, found that people with the healthiest lifestyle reduce their risk of type 2 diabetes by 75 percent, and their risk of cardiovascular disease by 49 percent.

By simply encouraging or perhaps requiring participation in these underutilized benefits, many patients with diabetes could improve their blood sugars and drastically reduce their risk of life-threatening complications, like amputation and blindness.

Complications are Serious

Every single day, approximately 230 people in the United States undergo an amputation related to a diabetic foot ulcer that becomes severely infected and untreatable, according to Dr. Foluso A. Fakorede in The American Journal of Managed Care.

More startling, Fakorede says every 30 seconds, someone across the globe loses a leg, and 85 percent of those are the result of diabetic foot ulcers that would have been otherwise preventable with adequate diabetes care.

Even after an amputation, these patients face a significantly high risk of enduring another severe infection that could result in another amputation — which means diabetes education isn’t being implemented or embraced despite severe complications.

Future Actions

The state of diabetes in the United States is getting worse, not better. Even patients with access to some form of diabetes education aren’t getting what they need to make a difference in their longterm health. 

Do patients need: 

• More support in their healthcare team? 
• More education from Medicare regarding the benefits of their healthcare plan? 

What these patients don’t need is another study on the benefits of improving lifestyle habits to improve blood sugars. 

Instead, the need practical help in implementing better diets.