The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education

Patient Educ Couns. 2016 Aug;99(8):1368-76. doi: 10.1016/j.pec.2016.03.017. Epub 2016 Mar 19.


Objective: To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support (DSME/S).

Methods: 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.

Results: 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.

Conclusion: 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%.

Practice implications: Both carbohydrate counting and the modified plate method improve glycemic control as part of DSME/S.

Keywords: Diabetes education; Numeracy; Nutrition; Type 2 diabetes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Diet, Diabetic
  • Dietary Carbohydrates / administration & dosage*
  • Dietary Carbohydrates / metabolism
  • Female
  • Glycated Hemoglobin A / analysis
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Education as Topic*
  • Self Care / methods*


  • Blood Glucose
  • Dietary Carbohydrates
  • Glycated Hemoglobin A