title: Digital photography as an educational food logging tool in obese patients with type 2 diabetes: lessons learned from a randomized, crossover pilot trial.
abstract: The purpose of this pilot study is to investigate the utility of, and areas of refinement for, digital photography as an educational tool for food logging in obese patients with type 2 diabetes (T2DM).
  
  
  
  Thirty-three patients aged 18 to 70 with T2DM, body mass index at least 30 kg/m(2), and A1C 7.5% to 9% were recruited from an endocrinology clinic and randomized to a week of food logging using a digital camera (DC) or paper diary (PD), crossing over for week 2. Patients then viewed a presentation about dietary effects on blood glucose, using patient DC and blood glucose entries. Outcomes of adherence (based on number of weekly entries), changes in mean blood glucose and frequency of blood glucose checks, and patient satisfaction were compared between methods. Patient feedback on the DC intervention and presentation was also analyzed.
  
  
  
  Thirty patients completed the study. Adherence was identical across methods. The mean difference in number of entries was not significant between methods. This difference increased and neared statistical significance (favoring DC) among patients who were adherent for at least 1 week (21 entries, with 2 entries per day for 5 of 7 days, n = 25). Mean blood glucose did not significantly decrease in either method. Patient satisfaction was similar between interventions. Feedback indicated concerns over photograph accuracy, forgetting to use the cameras, and embarrassment using them in public.
  
  
  
  Although the DC method was comparable to PD in adherence, blood glucose changes, and patient satisfaction in this pilot trial, patient feedback suggested specific areas of refinement to maximize utility of DC-based food logging as an educational tool in T2DM.
authors.affiliation: Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Ehrmann
authors.affiliation: Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)|Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
authors.forename: Robert M
authors.initials: RM
authors.lastname: Anderson
authors.affiliation: Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)|Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Piatt
authors.affiliation: Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)|Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Anderson, Dr Piatt, Ms Funnell)
authors.forename: Martha M
authors.initials: MM
authors.lastname: Funnell
authors.affiliation: Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
authors.forename: Hira
authors.initials: H
authors.lastname: Rashid
authors.affiliation: Department of Biostatistics, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan (Dr Shedden)
authors.forename: Kerby
authors.initials: K
authors.lastname: Shedden
authors.affiliation: Department of Internal Medicine, Division of Metabolism, University of Michigan Health System, Endocrinology, and Diabetes, Ann Arbor, Michigan (Mr Ehrmann, Ms Rashid, Dr Douyon)
authors.forename: Liselle
authors.initials: L
authors.lastname: Douyon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D004032:Diet / Q000523:psychology* / Q000706:statistics & numerical data; D015930:Diet Records; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010781:Photography; D010865:Pilot Projects; D011788:Quality of Life; D015203:Reproducibility of Results
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human