Manual of Clinical Nutrition Management III- 21 Copyright © 2013 Compass Group, Inc.
MONITORING IN DIABETES MELLITUS
Nutrition Evaluation and Monitoring
The following information provides relevant outcomes used in the determination of nutrition diagnosis and
evaluation and monitoring of medical nutrition therapy. The comprehensive list provides the suggested
monitoring parameters used to assess and evaluate the management and progression of diabetes mellitus
(type 1, type 2, or gestational diabetes mellitus [GDM]). The information below provides the objective
outcomes that support the rationale for providing medical nutrition therapy and self-management training to
persons with diabetes mellitus. The outcome parameters that the dietitian will select to evaluate and monitor
are determined by the patient’s stage of disease (new diagnosis vs. follow-up), type of diabetes, and
presenting signs and symptoms. The dietitian can strengthen his or her role as a participating member of the
health care team by understanding the impact and interpretation of these outcomes. When developing the
individual patient care plan, the dietitian selectively discusses only those assessment and monitoring
outcome parameters that are pertinent to the patient’s signs and symptoms or nutrition-related diagnosis.
Laboratory studies
(1):
Fasting plasma glucose (plasma glucose values are 10% to 15% higher than
whole blood glucose values)
Serial blood glucose levels before each meal, before evening snack, 3 AM,
postprandial
A1C test or A1C, also referred to as glycated hemoglobin (GHb),
glycohemoglobin, glycosylated hemoglobin, HbA1c, or HbA1.
Glycated serum protein (GSP; shorter half-life [1 to 2 weeks] than GHb [2 to 3
months]; preferred to GHb when anemia is present)
Fasting lipid profile, including high-density lipoprotein (HDL), low-density
lipoprotein (LDL), very-low-density lipoprotein (VLDL), triglycerides, and total
cholesterol Renal function indexes (microalbuminuria, serum creatinine in
adults, in children if proteinuria is present)
Test for microalbuminuria (eg, timed specimen or urine albumin-to-creatinine
ratio (UACR)
Glucose in urine (limited use and not recommended for use in GDM),
Urine and blood ketone testing (recommended in type 1 diabetes, pregnancy
with existing diabetes and GDM)
Electrolytes
Thyroid function tests (for type 1 diabetes at diagnosis and then every 1- 2
years)
C-peptide
Immunoglobulin A (IgA), tissue transglutaminase (tTg) antibodies or
antiendomysial antibodies (anti-EMA) for persons with type 1 diabetes who
present with signs or symptoms of celiac disease
Medical-clinical (1): Insulin regimen and/or oral agent
Blood pressure
Comprehensive medical review
Review of coexisting medical conditions
Current weight, body mass index, weight history, desirable weight (mutually agreed
on goal) goal weight, growth and development pattern (children, adolescents)
Activity level (exercise pattern)
Nutrition history and typical food intake (meal and snack times; percent of
kilocalories from protein, carbohydrate, and fat)
Self-monitoring of blood glucose (SMBG) level and pattern (Plasma glucose values
are 10% to 15% higher than whole blood glucose values, and it is crucial that
people with diabetes know whether their monitor and strips provide whole blood
or plasma results.)
Social: Relevant social factors, such as access to health care, employment schedule/school,
culture, literacy level, family support, financial resources, possibly alcohol or other
substance abuse, self-monitoring strategies (eg, SMBG records), and previous
treatment programs, including nutrition and diabetes self-management training
Values in the reference range are different for HbA 1 vs HbA1c (2).