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To evaluate the feasibility, acceptability, and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia, as detected based on the measurement of hemoglobin A1C (HbA1C).Forty participants with T1D for1 year and an HbA1C level of ≥9.5% (80 mmol/mol) enrolled for a multidisciplinary intervention that included pediatric endocrinologists, pediatric psychologists, and a certified diabetes care and education specialist (CDCES). The CDCES-integrated medical management, while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals and reviewed medication adjustments. The feasibility was assessed based on enrollment targets; acceptability based on retention rates; and preliminary efficacy based on changes in HbA1C levels, quality of life, diabetes-related strengths and resilience, hospital admissions, emergency room visits, and missed school days.Of 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention, and 31 completed full 8 months of follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. The HbA1C level reduced significantly from baseline to 4 months (12.1% ± 1.6% to 11.0% ± 1.9%, P = .001) and was sustained at 8 months (10.7% ± 1.9%, P.001). The participants reported significant increases in diabetes-specific quality of life (P.05) and diabetes-related strength and resilience (P = .003). The missed school days reduced from 7.23 ± 7.5 days to 1.55 ± 1.9 days (P.001), and the diabetes-related hospitalizations decreased from 0.4 ± 0.6 to 0.1 ± 0.3 (P = .009).Preliminary data suggest that a multidisciplinary intervention leveraging a team-based approach with a physician, psychologist, and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with T1D with an HbA1C level above the target.

Medical nutrition therapy for people with diabetes should be individualized, with consideration given to the individual's usual food and eating habits, metabolic profile, treatment goals and desired outcomes. Monitoring of metabolic parameters, including glucose, HbA1c, lipids, blood pressure, body weight, and renal function, when appropriate, as well as quality of life is essential to assess the need for changes in therapy and ensure successful outcomes. Ongoing nutrition self-management education and care needs to be available for individuals with diabetes. Additionally many areas of nutrition and diabetes require additional research.

This article discusses methods for monitoring diabetes therapy. Emphasis is placed on client assessment and selection of appropriate products to ensure accurate results.

Advances in diabetes management and the variety of nutrition care services available to individuals with diabetes make this an exciting time for dietetics professionals to be working in the field of diabetes. Evidence supporting the effectiveness of medical nutrition therapy (MNT) for diabetes management continues to grow, with documented decreases in A1C of 2% in cases of newly diagnosed type 2 diabetes, and of 1% in cases of type 2 diabetes with an average duration of 4 years and in newly diagnosed people with type 1 diabetes (1). These outcomes are highly significant. For example, for a person newly diagnosed with type 2 diabetes who initially has an A1C of 9.0% and sees a registered dietitian for MNT, the expected outcome would be a reduction of A1C to 7.0%, which actually represents a 24% improvement. In January 2002, the American Diabetes Association published an updated position statement, “Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications” (2), along with a technical review that discusses in detail the published research for each principle and recommendation (3). These recommendations replace previous documents written in 1994. Additionally, the American Dietetic Association (ADA) and the Diabetes Care and Education dietetic practice group developed Medical Nutrition Therapy Evidence-Based Guides for Practice—nutrition practice guidelines for type 1 diabetes, type 2 diabetes (4), and gestational diabetes mellitus (5), as well as other diseases. The Centers for Medicare and Medicaid Services requires use of nationally recognized protocols, such as the ADA evidence-based guides for practice, for the Medicare MNT benefit (6). In response to these events, the American Diabetes Association and the ADA initiated a review of the client education pieces they copublish. In early 2002, a Nutrition Publications Advisory Task Force was appointed by the publications departments of the two associations. The charges of this task force were to (a) review existing diabetes nutrition education publications for consumers; (b) evaluate their purpose and clinical usefulness based on actual sales data from the two associations, feedback from staff, and consensus of the experienced members of the task force; and (c) make recommendations to staff for revisions. The primary goal was to ensure that all publications were consistent with the 2002 American Diabetes Association’s nutrition position statement and the ADA evidencebased guides for practice for diabetes care (type 1, type 2, and gestational diabetes).

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.