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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., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background and Aims: Diet may play an important role in the development of hyperuricemia and gout. However, the association between dietary factors and hyperuricemia remains unclear, and few studies have investigated direct links between food intake and hyperuricemia. The aim of this study was to investigate associations between high purine-content foods and protein intake with the prevalence of hyperuricemia by using data from a cross-sectional study of 3978 men aged 40-74 yrs living in Shanghai, China., Methods and Results: Hyperuricemia was defined as blood uric acid level >7.0 mg/dl. One quarter of this population had hyperuricemia. Dietary information was collected by using a food frequency questionnaire. We collected information on anthropometric measurements and lifestyle factors and other potential confounding factors and disease history via interviews. Total protein consumption was not associated with hyperuricemia. We found a positive association between protein from animal sources and prevalence of hyperuricemia and an inverse association between protein from plant sources and hyperuricemia. However, these associations failed to reach significance in mutually adjusted analysis. Seafood intake was associated with higher prevalence of hyperuricemia. The ORs for quintiles of seafood intake (including fish and shellfish) were 1.00, 1.49, 1.35, 1.34, and 1.56 (p for trend: 0.01). An inverse association approaching significance between soy food consumption and hyperuricemia was observed (ORs: 1.00, 0.90, 0.70, 0.89, and 0.77 for quintiles of intake; p for trend: 0.07). No associations between consumption of purine-rich vegetables or meat and prevalence of hyperuricemia were observed., Conclusions: Our data suggest a direct association between seafood consumption and hyperuricemia and an inverse association between consumption of soy food and hyperuricemia among middle-aged, Chinese men., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background and Aim: Increased levels of C-reactive protein (CRP), common in aging populations, are associated with higher risk for chronic diseases, including diabetes and coronary heart disease. The aim of this study was to investigate associations between lifestyle factors and high CRP among middle-aged men living in Shanghai, China., Methods and Results: In this cross-sectional study, 3978 urban Chinese men aged 40-74 years who were free of type-2 diabetes at baseline provided fasting blood samples, anthropometric measurements and information on lifestyle factors and disease history. Dietary patterns were assessed by factor analysis. Participants were categorised into two groups according to CRP level: normal (≤ 3 mg/L) and high (> 3 mg/L). Associations between CRP categories and lifestyle factors were investigated by using logistic regression. Obesity, weight gain, cigarette smoking and alcohol intake were positively associated with high CRP levels, while physical activity and a dietary pattern with high consumption of fruit were inversely related to high CRP levels. A positive trend of marginal significance between quintiles of a dietary pattern with high consumption of meat and high CRP levels was also observed. No association between tea intake and CRP level was observed., Conclusions: Components of an adverse lifestyle were associated with high CRP levels. Obesity, smoking and alcohol intake were associated with high CRP, a biomarker of low-grade inflammation in middle-aged men, while a dietary pattern rich in fruit and high physical activity were inversely associated with the prevalence of high CRP., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Long-chain polyunsaturated n-3 (omega-3) fatty acids, found mainly in fish, have been postulated to reduce type 2 diabetes (T2D) risk. However, the role of long-chain n-3 fatty acids and fish intake in the development of T2D remains unresolved., Objective: We examined associations between fish, shellfish, and long-chain n-3 fatty acids and the risk of T2D in a middle-aged Chinese population., Design: This was a prospective population-based cohort study in 51,963 men and 64,193 women free of T2D, cardiovascular disease, and cancer at baseline with valid dietary information. Dietary intake, physical activity, and anthropometric measurements were collected. A Cox regression model was used to evaluate the association of fish, shellfish, and long-chain n-3 fatty acid (in g/d) with risk of T2D., Results: Fish, shellfish, and long-chain n-3 fatty acid intakes were inversely associated with T2D in women. The relative risks [RRs (95% CI)] for quintiles of fish intake were 1.00, 0.96 (0.86, 1.06), 0.84 (0.75, 0.94), 0.80 (0.71, 0.90), and 0.89 (0.78, 1.01) (P for trend = 0.003) and for shellfish were 1.00, 0.91 (0.82, 1.01), 0.79 (0.71, 0.89), 0.80 (0.71, 0.91), and 0.86 (0.76, 0.99) (P for trend = 0.006). In men, only the association between shellfish intake and T2D was significant. The RRs (95% CI) for quintiles of fish intake were 1.00, 0.92 (0.75, 1.13), 0.80 (0.65, 1.00), 0.89 (0.72, 1.11), and 0.94 (0.74, 1.17) (P for trend = 0.50) and for shellfish intake were 1.00, 0.93 (0.76, 1.12), 0.70 (0.56, 086), 0.66 (0.53, 0.82), and 0.82 (0.65, 1.02) (P for trend = 0.003)., Conclusions: An inverse association between fish and shellfish intake and T2D in women was found. No evidence of a detrimental effect of fish intake in this population was observed.

Objective: Prior studies have suggested socioeconomic differences in outcome expectations for diabetes. This paper explores outcome expectations of adults of varied socioeconomic status with type 2 diabetes, examining differences between African Americans and whites., Design: A qualitative study using focus groups of individuals with type 2 diabetes. Interviews were tape recorded and transcribed verbatim. Data analysis was based on the constant comparative method, assisted by qualitative analysis software. Research was done in outpatient clinics in both a community health center and tertiary care center., Participants: Seventy-one participants, 46% African American, 54% with household income less than or equal to $40,000, diagnosed with type 2 diabetes for at least 1 year., Interventions: Subjects discussed coping mechanisms, including self-control, compliance discipline, and denial regarding diabetes., Results: Behavior control was typified as (1) beliefs about controlling diabetes and (2) beliefs about controlling one's behavior aside from diabetes control. Patients described a range of strategies, including beliefs as self-efficacy, confidence and willingness to take on self-management, and. positive and negative outcome expectations about ability to modify the natural course of the disease., Conclusions: Those of higher socioeconomic status espoused more positive outcome expectations and self-efficacy, while poorer subjects reported more negative outcome expectations. Factors such as perception of control may contribute to root causes of socioeconomic disparities seen in diabetes outcomes. INTERVENTIONS to increase compliance should address class-specific disease perceptions. Practical support that builds on patients' preferred strategies could help improve diabetes disparities.

We examined associations between fruit and vegetable intake and the incidence of type 2 diabetes (T2D) in a population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information. Dietary intake was assessed by in-person interviews using a validated FFQ. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. We used a Cox regression model to evaluate the association of fruit and vegetable intake (g/d) with the risk of T2D. Quintiles of vegetable intake and T2D were inversely associated. The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61-0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D. Fruit intake was not associated with the incidence of diabetes in this population. Our data suggest that vegetable consumption may protect against the development of T2D.

Diabetes education is a cornerstone of diabetes self-care management. Despite terrific progress in refining educational interventions, the diabetes literature continues to contain substantial inconsistencies in reporting the elements of educational interventions. This unnecessary variation in the quality of reporting has led to difficulties in understanding the results of educational research in diabetes. We provide a taxonomy that should prove helpful, both in the conceptual design of diabetes educational interventions and in the reporting of those interventions. An application of this taxonomy to 30 diabetes educational randomized controlled trials is presented to highlight the extent of variation in diabetes educational interventions.