The Honorable John Garamendi

Congressman
2438 Rayburn HOB
Washington, DC 20515
April 15th 2018
H.R. 3124: Support
Dear Congressman John Garamendi,

As a Dietetics student at San Diego State University, I am writing to you in support of

H.R. 3124. This is the legislation aimed to extend Medicare coverage for medical
nutrition therapy practices to be used to help patients with pre-diabetes or at a risk for
developing Type 2 Diabetes.

Americans with pre-diabetes or whom are at risk for Type 2 Diabetes deserve to be
treated with the utmost care. Medicare provides health insurance for Americans over
the age of 65, certain people with disabilities, and people with end-stage renal disease.
This being said, being over the age of 45, having certain disabilities, and having end-
stage renal disease all increase the risk of acquiring Type 2 Diabetes. Americans living
with Medicare have this increased risk and should be consulting with Registered
Dietitian Nutritionists (RDNs) in order to prevent the onset of Type 2 Diabetes.

According to an article published in the World Journal of Diabetes, half of the population
over the age of 75 have a pre-diabetes status. They also note that lifestyle changes,
such as a loss of 7% of body weight, can prevent the development of Type 2 Diabetes.
This is important information considering that RDNs are trained and specialize in
motivational interviewing, using the stages of change model, and educating on a healthy
diet- which all lead to weight loss.

With the prevalence of pre-diabetes being so high in the Medicare population and both
weight loss being and nutrition education being proven to delay or prevent the
development of diabetes, it makes sense to have RDN’s medical nutrition therapy be
covered by Medicare for patients with pre-diabetes of at a risk for developing Type 2
Diabetes.

While it is understood that Medicare covering RDNs for their medical nutrition therapy in
Americans with pre-diabetes or at a risk for developing Type 2 Diabetes would be
costly, it would save money in the long run. According to the American Diabetes
Association, people who have been diagnosed with diabetes have an average medical
expenditure of about $13,700 a year with $7,900 of it being due to the diabetes; this is
2.3 times higher than the expenditure would be if there was no diabetes diagnosed. If
RDNs can do what they have proven to do and help prevent the development of
diabetes in patients who have pre-diabetes or are at risk, then this can save millions in
health insurance expenditures.

I know if I had a loved one who was at risk for developing diabetes and was being
covered by Medicare, I would want them to be able to see a RDN so they could be
helped before the onset of Type 2 Diabetes; I wouldn’t want to wait until it was too late. I
would know that they are an American who has earned the eligibility to be on Medicare
and should be taken care of to the fullest extent.

For these reasons, I support H.R. 3124 and urge you to support it as well. Thank you for
taking the time to read my letter.

Respectfully,

Karina Jaime Carbajal

San Diego State University
Didactic Program in Dietetics (DPD)