FIM interventions work best when they are adaptable to changes in a person’s health status, life circumstances, and preferences. Just as clinical treatments can be stepped up or down in intensity, nutrition support can follow a similar path. Through shared decision-making, providers and patients can adjust support based on evolving needs. This approach supports patient autonomy, maximizes resource efficiency, and reinforces nutrition as part of routine care.
Escalate support (“step up”) when a patient’s condition worsens (e.g. worse glycemic control) or new stressors arise (e.g. very low food security develops).
Maintain or taper (“step down”) when stability improves. Continue providing nutrition education and supporting access to community food resources as needed.
Example Initial Patient Status
Stable diabetes, low to moderate social risk
Poor diabetes control, high social risk
Poor diabetes control, low social risk
Example Change in Patient Status
Acute hospitalization (e.g., heart attack), new diagnosis, physical limitations
Worsening diabetes control or new life stressor (e.g., lost job, food insecure)
Recovered stability (e.g. HbA1c <8%), social risks persist (e.g. food insecure)
Recovered stability (e.g. HbA1c <8%), social risks improve (e.g. food secure)
Recommended Support
Step up from MTG to MTM
Step up from PRx to MTG
Step down from MTG to PRx
Step down from PRx to nutrition education alone
Goal
Stabilize health, prevent readmission
Improve diabetes control, address emergent food insecurity
Improve diabetes control and nutritious food access
Transition to diabetes self-management