September 2022 Drop In Q&A with MCT2D Health Educator and Dietitian Rina

Find the most recent Drop-In Q&A session with MCT2D Dietitian and Health Educator, Rina Hisamatsu, recorded September 16, 2022.

Q&A from the Session

Q: Can you share resources for office staff to learn and then instruct/teach patients at point of care?

Q: Please comment on relative opposite recommendations from recent expert consensus statement from the American College of Lifestyle Medicine on dietary interventions for remission of T2DM.

A. While the report concludes that the primary dietary intervention most effective in achieving remission in T2D is centered on a whole-foods, plant-based diet with minimal consumption of meat and other animal products, it may be more complicated than this. There is often a misconception that ‘low-carb’ equals ‘high animal protein’ when in fact that is not necessarily the case. Protein recommendations are typically just modestly higher than the RDA for most individuals and are adjusted based on individual needs. Plant-based protein sources such as tofu, tempeh, and edamame are also encouraged options for low-carb meal plans. In addition, contrary to what the article suggests, we see some overlaps between dietary patterns that are promoted in the article. For example, very-low energy meal replacements used in many medical weight management programs typically support a total daily carb intake of <120g total carbs/day which, by definition, is also a low-carbohydrate eating pattern. As highlighted in the ADA’s consensus report, individualized nutrition therapy is key to creating the biggest impact to the population, with low-carbohydrate diets being a potential intervention. Rather than choosing a one-size fits all approach in the treatment of T2D, we believe individuals should be evaluated case by case and recommendations should be tailored based on the individual’s background, experiences, and what they are willing to change. For example, if an individual’s baseline intake includes high consumption of red meat and processed carbs, an intervention focusing on reducing processed carb intake can support better health outcomes even if the patient continues to eat the same amount of meat.

Q: A recent article in Annals of Internal Medicine suggested that Motivational Interviewing is not effective in addressing obesity. Any thoughts on that?

A: Although the authors conclude that MI may not be effective as a standalone intervention for the treatment of obesity, it may still play an important role in weight management. We recognize that obesity is a multifaceted disease with complex etiology, with many factors in the mix that are beyond the patient’s control (including genetics, environment, access to healthy foods etc.) Utilizing MI tools may have positive outcomes in behavior change when combined with other therapies including medication, dietary change (low-carb meal plan), and CGM use, which together build the foundational pillars of MCT2D. We believe MI is just the first step to better understanding patient motivations and bringing to light their intrinsic motivations and their willingness to make changes. Training clinicians to use MI principles such as expressing empathy and respecting patient’s autonomy can provide a framework to engage patients in healthy behaviors through shared decision-making. Furthermore, there is potential for MI to increase patient’s adherence to certain lifestyle changes such as adherence to medications.

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Blue Cross Blue Shield Blue Care Network of Michigan

Support for the Michigan Collaborative on Type 2 Diabetes is provided by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. BCBSM’s Value Partnerships program provides clinical and executive support for all CQI programs. To learn more about Value Partnerships, visit Although Blue Cross Blue Shield of Michigan and the Michigan Collaborative on Type 2 Diabetes work in partnership, the opinions, beliefs, and viewpoints expressed by MCT2D do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.