A Time-Friendly, Feasible Measure of Nutrition Knowledge in Type 1 Diabetes: The Electronic Nutrition and Carbohydrate Counting Quiz (eNCQ)

J Diabetes Sci Technol. 2019 Jan;13(1):68-74. doi: 10.1177/1932296818778608. Epub 2018 Jun 1.

Abstract

Background: Greater knowledge about nutrition and carbohydrate counting are associated with improved glycemic control and quality of life in youth with type 1 diabetes (T1D). However, limited assessments of nutrition and carbohydrate knowledge have been developed, and existing measures can be time-consuming, overly broad, or not conducive to routine clinical use. To fill this gap, we developed and examined the feasibility of administering the electronic Nutrition and Carbohydrate Counting Quiz (eNCQ).

Method: Ninety-two caregivers and 70 youth with T1D (mean age 12.5 years; mean time since diagnosis 5 years; English speaking) completed the 19-item eNCQ via tablet during a routine clinical visit. Completion time and item completion rates were used to assess feasibility. Relationships between eNCQ scores and patient demographics, diabetes management, and health outcomes were examined.

Results: Participants took 10 minutes, on average, to complete the eNCQ. Total and Carbohydrate subscale scores (youth report) were negatively correlated with youth hemoglobin A1c (total r = -.38, carbohydrate r = -.38, Ps < .05), indicating that greater nutrition knowledge related to better glycemic control. Nutrition knowledge scores were generally high, but knowledge was negatively related to time since diabetes diagnosis ( r = -.276, P < .05).

Conclusions: Findings support feasibility of the eNCQ to assess nutrition knowledge in routine clinical care. Following additional acceptability and validity testing, the eNCQ may identify families in need of further nutrition education. Nutrition assessment is particularly indicated for youth over one year since T1D diagnosis, as these families displayed lower nutrition knowledge and may need continuing education to maintain diabetes-specific nutrition knowledge over time.

Keywords: assessment; carbohydrate counting; glycemic control; nutrition; type 1 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Caregivers*
  • Child
  • Child, Preschool
  • Computers, Handheld
  • Data Collection
  • Diabetes Mellitus, Type 1 / therapy*
  • Dietary Carbohydrates / administration & dosage*
  • Electronic Health Records
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Infant
  • Insulin / therapeutic use
  • Male
  • Midwestern United States
  • Nutritional Status*
  • Parents
  • Patient Education as Topic / methods*
  • Psychometrics
  • Quality of Life
  • Surveys and Questionnaires
  • User-Computer Interface
  • Young Adult

Substances

  • Dietary Carbohydrates
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human