Randomized Nutrition Education Intervention to Improve Carbohydrate Counting in Adolescents with Type 1 Diabetes Study: Is More Intensive Education Needed?

Background Youth with type 1 diabetes do not count carbohydrates accurately, yet it is an important strategy in blood glucose control. Objective The study objective was to determine whether a nutrition education intervention would improve carbohydrate counting accuracy and glycemic control. Design We conducted a randomized, controlled nutrition intervention trial that was recruited from February 2009 to February 2010. Subjects Youth (12 to 18 years of age, n=101) with type 1 diabetes were screened to identify those with poor carbohydrate counting accuracy, using a previously developed carbohydrate counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n=66, age=15 +/- 3 years, 41 male, diabetes duration=6 +/- 4 years, hemoglobin A1c [HbA1c]=8.3%+/- 1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90-minute class with a registered dietitian/certified diabetes educator and twice kept 3-day food records, which were used to review carbohydrate counting progress. Main outcome measures Carbohydrate counting accuracy (measured as described) and HbA1c were evaluated at baseline and 3 months to determine the effectiveness of the intervention. Statistical analyses performed t Tests, Spearman correlations, and repeated measures models were used. Results At baseline, carbohydrate content was over- and underestimated in 16 and 5 of 29 food items, respectively. When foods were presented as mixed meals, participants either significantly over- or underestimated 10 of the 9 meals and 4 snacks. After 3 months of follow-up, HbA1c decreased in both the intervention and control groups by -0.19%+/- 0.12% (P=0.12) and -0.08%+/- 0.11% (P=0.51), respectively; however, the overall intervention effect was not statistically significant for change in HbA1c or carbohydrate counting accuracy. Conclusions More intensive intervention might be required to improve adolescents' carbohydrate counting accuracy and nutrition management of type 1 diabetes. Additional research is needed to translate nutrition education into improved health outcomes. J Acad Nutr Diet. 2012;112:1736-1746.