
Written by Olivia Farrow, RD, MHS
Reviewed by Maria Dellanina, RDN
For dietitians, writing a PES statement for diabetes can initially seem daunting, but it’s an important skill for communicating their nutrition diagnosis effectively. Dietitians play an essential role in diabetes management. Nutrition therapy helps to prevent type 2 diabetes mellitus (T2DM), manage all types of diabetes and slow the progression of diabetes complications. Nutrition therapy by a registered dietitian is recommended by most national diabetes guidelines.
If you want to learn how to write or perfect your PES statements, check out DSC’s other PES statement resources:
- How to write a PES Statement Blog Article
- How to Write a PES Statement Youtube Video
- Nutrition Diagnosis Example Blog Article
- How to use the Nutrition Care Process (NCP) & ADIME in Practice Blog Article
- PES Statement Cheat Sheet
In this article, we’ll walk you through the process of writing a PES statement tailored specifically for diabetes.
Quick Links
Goals of Nutrition Interventions
Diabetes management requires addressing a variety of factors, including blood glucose control, dietary habits, and potential complications. When crafting a PES statement for diabetes, it’s important to focus on the specific nutrition-related issues that can be influenced through dietary intervention.
Nutrition therapy should be individualized to enhance quality of life by promoting well-being and diabetes control. While we want to avoid giving prescriptive nutrition directions to our diabetes patients, having a defined nutrition goal to focus on can help give you and your patient more clarity toward the nutritional steps needed to achieve overall health goals.
Ultimately, the objectives of nutrition therapy are to (Sievenpiper, 2018, Evert, 2013):
- Attain and maintain individualized glycemic, blood pressure, body weight, and/or lipid goals.
- Delay or prevent the complications of diabetes.
In doing so, dietitians must consider the patient’s personal and cultural preferences, health literacy, numeracy, access to healthful food choices, willingness and ability to make behavioral changes, as well as barriers to change (Evert, 2013). Additionally, maintaining the pleasure of eating by providing nonjudgmental messages about food choices, and offering practical tools for day-to-day meal planning rather than focusing too heavily on individual macronutrients, micronutrients, or single foods (Evert, 2013).
For individuals with type 1 diabetes mellitus (T1DM), intensive flexible insulin therapy with carbohydrate counting can improve glycemic control and may be the right approach for some individuals (Evert, 2013).
Components of a Diabetes-Specific PES Statement
1. Problem (P)
The PES statement problem helps to identify the primary nutrition-related issue that can be improved or resolved through dietary intervention. With a PES statement for diabetes your problem might come from one of the following components of the NCP diagnostic terminology:
- Intake domain (recall that the intake domain is always preferred when writing a PES statement because it is the main area that can be addressed by a dietitian!)
- Energy balance – for instance, if excessive energy intake is contributing to prediabetes or T2DM risk or complications. In some cases, reduced energy intake can result in improvements in HbA1c and/or reduced risk of developing T2DM from prediabetes (Sievienpiper, 2018).
- Nutrient, and most commonly Carbohydrate and Fiber, for example:
- Excessive carbohydrate intake
- Inappropriate intake of types of carbohydrate (specify; e.g., refined, high glycemic index, simple sugars)
- Inconsistent carbohydrate intake
- Inadequate fiber intake
- Clinical Domain
- Impaired nutrient utilization (in T1DM)
- Altered nutrition-related laboratory values (HbA1c, fasting glucose, etc.)
- Behavioral-Environmental Domain
- Food and nutrition related knowledge deficit
- Not ready for nutrition related behavior change
- Self-monitoring deficit
- Limited adherence to nutrition related recommendations
- Physical inactivity
- Inability or lack of desire to manage self-care
- Limited access to nutrition related supplies
2. Etiology (E)
The PES statement etiology specifies the root cause of the problem that you, as a dietitian, can address. For diabetes, this might involve:
- Limited food and nutrition related knowledge
- Limited access to healthful food choices
- Belief that hinders food and/or nutrition behavior change
- Limited motivation and/or readiness to change
- Increased carbohydrate needs secondary to increased physical activity
- Modified requirements secondary to diabetes mellitus
- Uncontrolled diabetes / poor glycemic control
- New diagnosis of diabetes
Or others, depending on the problem and the patient’s individual nutrition requirements and/or goals.
3. Signs & Symptoms (S)
The PES statement states the contributing facts that tell you the problem and etiology exist. They provide evidence of the nutrition problem. These should be specific and measurable. For diabetes, the most common signs and symptoms include:
- Elevated blood glucose levels (e.g., fasting blood glucose >126 mg/dL)
- Hemoglobin A1c levels above target range (e.g., >7%)
- Patient reports of frequent hyperglycemic and/or hypoglycemic episodes
- Diet recall showing… (e.g., limited consumption of fiber-rich foods, excessive consumption of sugar sweetened beverages, carbohydrate intake 3x daily recommended amount)
- No formal diabetes education
Structuring Your Diabetes PES Statement
Combine the three components into a structured sentence using the phrases “related to” and “as evidenced by.”
The PROBLEM related to ETIOLOGY as evidenced by SIGNS and SYMPTOMS.
Sample PES Statements for Diabetes
To help you get started, here are some examples of PES statements for diabetes:
Example 1: Inconsistent Carbohydrate Intake
PES Statement: Inconsistent carbohydrate intake related to limited food and nutrition related knowledge concerning appropriate carbohydrate intake as evidenced by diet recall showing erratic carbohydrate eating pattern, client report of restriction and subsequent excessive consumption of carbohydrate foods, elevated HbA1C of 8.9%.
Example 2: Inadequate fiber consumption
Inadequate fiber intake related to limited food and nutrition knowledge concerning importance of fiber-rich foods for diabetes as evidenced by limited formal diabetes education, diet history showing only low-fiber carbohydrate foods consumed, elevated postprandial glucose levels consistently above 10 mmol/L.
Example 3: Food and nutrition related knowledge deficit
PES Statement: Food and nutrition related knowledge deficit related to new diagnosis of type 1 diabetes as evidenced by patient report of no formal diabetes nutrition education, limited knowledge of carbohydrate-containing foods, new insulin pump requiring carbohydrate input.
Example 4: Excessive carbohydrate intake
PES Statement: Excessive carbohydrate intake related to frequent consumption of sugar sweetened beverages and bread as evidenced by 24-hour recall showing ¾ of total food and beverage consumption containing carbohydrates, carbohydrate intake > estimated requirement, diet recall showing consumption of approx. 4 liters of soda pop and 10 slices of bread each day, new diagnosis of prediabetes.
Example 5: Limited adherence to nutrition related recommendations
PES Statement: Limited adherence to diabetes nutrition related recommendations related to lack of motivation and readiness for behavior change as evidenced by patient report of disinterest in nutrition education or counseling and lack of motivation for dietary changes, elevated HbA1c of 8.5%.
Tips for Writing Effective PES Statements for Diabetes
- Be Specific: Ensure that the problem, etiology, and signs & symptoms are specific to the individual’s diabetes management needs.
- Focus on Modifiable Factors: Choose etiologies that you can address through nutrition therapy interventions.
- Use Measurable Data: Utilize quantitative data such as blood glucose levels, hemoglobin A1c values, and diet recall data to provide clear evidence.
Conclusion
Writing a PES statement for diabetes involves understanding the unique nutritional challenges faced by individuals with this condition. By identifying specific problems, root causes, and measurable signs and symptoms, you can create effective and targeted PES statements to guide your nutrition interventions. Use the examples and tips provided to enhance your practice and improve your patients’ outcomes.
Don’t forget to download our free Nutrition PES Statement Cheat Sheet for more sample statements and guidance!
References
- Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition Therapy. Can J Diabetes. 2018;42(Suppl 1)
- Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS Jr; American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013 Nov;36(11):3821-42. doi: 10.2337/dc13-2042. Epub 2013 Oct 9. PMID: 24107659; PMCID: PMC3816916.