Randomized nutrition education intervention to improve carbohydrate counting in adolescents with type 1 diabetes study: is more intensive education needed?

J Acad Nutr Diet. 2012 Nov;112(11):1736-46. doi: 10.1016/j.jand.2012.06.001. Epub 2012 Sep 11.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism
  • Carbohydrate Metabolism / physiology
  • Child
  • Child Nutrition Sciences / education*
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Diet, Diabetic*
  • Dietary Carbohydrates / administration & dosage*
  • Dietary Carbohydrates / metabolism
  • Female
  • Food Analysis / standards
  • Glycated Hemoglobin / analysis*
  • Glycated Hemoglobin / metabolism
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Male
  • Patient Education as Topic*
  • Statistics, Nonparametric
  • Treatment Outcome


  • Blood Glucose
  • Dietary Carbohydrates
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin