In Reply: We thank Dr Hager and Ms Michael for reminding us that a physician's referral is required for Medicare to cover medical nutrition counseling. Although such consultations have the potential to simplify the nutritional recommendations contained in multiple CPGs, they also require additional health care visits for the patient. More problematic is the limited amount of evidence about the changing nutritional needs of older patients, which has led the American Diabetes Association CPG to state that “nutrition recommendations for older adults with diabetes must be extrapolated from what is known from the general population.”1
Boyd CM, Darer JD, Boult C, Fried LP, Boult L, Wu AW. Clinical Practice Guidelines for Older Patients With Comorbid Diseases—Reply. JAMA. 2006;295(1):33–35. doi:10.1001/jama.295.1.34-b
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