title: The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education.
abstract: To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support (DSME/S).
  
  
  
  We randomized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education. The primary outcome was change in HbA1C over 6 months.
  
  
  
  At 6 months, HbA1C improved within the plate method [-0.83% (-1.29, -0.33), P<0.001] and carbohydrate counting [-0.63% (-1.03, -0.18), P=0.04] groups but not the control group [P=0.34]. Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months (carbohydrate counting, P=0.36; modified plate method, P=0.08). In a pre-specified subgroup analysis of patients with a baseline HbA1C 7-10%, change in HbA1C from baseline improved in the carbohydrate counting [-0.86% (-1.47, -0.26), P=0.006] and plate method groups [-0.76% (-1.33, -0.19), P=0.01] compared to controls.
  
  
  
  CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10%.
  
  
  
  Both carbohydrate counting and the modified plate method improve glycemic control as part of DSME/S.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Outcomes and Health Services Research, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowen
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA; Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
authors.affiliation: Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wolff
authors.affiliation: Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Dianne
authors.initials: D
authors.lastname: Davis
authors.affiliation: Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Gregory
authors.affiliation: Department of Biostatistics, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.affiliation: Department of Biostatistics, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Eden
authors.affiliation: School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Wallston
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, School of Medicine, Nashville, TN, USA; Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Elasy
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, School of Medicine, Nashville, TN, USA; Vanderbilt Diabetes Center, Vanderbilt University, School of Medicine, Nashville, TN, USA. Electronic address: russell.rothman@vanderbilt.edu.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods*
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin
keywords: Diabetes education; Numeracy; Nutrition; Type 2 diabetes