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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.

Background and Objectives: Incidence of type 1 diabetes mellitus (T1DM) is increasing, and these patients often have poor glycemic control. Electronic dashboards summating patient data have been shown to improve patient outcomes in other conditions. In addition, educating patients on T1DM has shown to improve glycated hemoglobin (A1C) levels. We hypothesized that using data from the electronic dashboard to monitor defined diabetes management activities to implement population-based interventions would improve patient outcomes. Methods: Inclusion criteria included patients aged 0 to 18 years at Phoenix Children’s Hospital with T1DM. Patient data were collected via the electronic dashboard, and both diabetes management activities (A1C, patient admissions, and visits to the emergency department) and patient outcomes (patient education, appointment compliance, follow-up after hospital admission) were analyzed. Results: This study revealed that following implementation of the electronic dashboard, the percentage of patients receiving appropriate education increased from 48% to 80% (Z-score = 23.55, P < .0001), the percentage of patients attending the appropriate number of appointments increased from 50% to 68.2%, and the percentage of patients receiving follow-up care within 40 days after a hospital admission increased from 43% to 70%. The median A1C level decreased from 9.1% to 8.2% (Z-score = −6.74, P < .0001), and patient admissions and visits to the emergency department decreased by 20%. Conclusions: This study shows, with the implementation of an electronic dashboard, we were able to improve outcomes for our pediatric patients with T1DM. This tool can be used at other institutions to improve care and outcomes for pediatric patients with T1DM and other chronic conditions.

Background: Youth with poorly controlled type 1 diabetes (T1D) are at increased risk for morbidity yet very few interventions have targeted this vulnerable population. The purpose of this study was to test the feasibility, acceptability and preliminary efficacy of an intensive, team-based intervention program for youth with HbA1c ≥ 9.5%. Methods: Forty patients (age 14.1±2.3 years, 53% male) with T1D (duration 6.5±4.3 years) were enrolled in an intensive, 4-month team-based intervention that included a visit with their primary endocrinologist and a pediatric psychologist at baseline as well as up to 6 encounters (in-person visits and calls) with a Certified Diabetes Educator (CDE). The CDE encounters were designed to establish goals, support behavior changes, review glucose logs, and make interim dose adjustments as needed. Feasibility was measured by the number of patients approached and the number of patients who ultimately agreed to participate, acceptability was measured by attendance and attrition rates, and preliminary efficacy was assessed by changes in HbA1c and diabetes-related Quality of Life (QoL). Data were collected at baseline and 4 months. Results: Of the 42 patients who were approached, 40 agreed to participate, and 35 (87.5%) completed the 4-month program. CDE engagement with patients included an average of 3 phone calls and 3 in-person visits. Compared to baseline, HbA1c reduced from 12.0%±1.6 at baseline to 11.0%±1.9 at the 4 month visit (p Conclusion: Intensive team-based interventions in pediatric patients with poorly controlled T1D can improve glycemic control and QoL. Disclosure M. Chambers: None. G.Q. Shaibi: None. C.R. Kapadia: None. F. Hoekstra: None. S.S. Puffenberger: None. L. Touger: None. I.K. Radcliffe: None. L. Holzmeister: None. K.A. Olsen: None. Funding Thomas J. Beatson, Jr. Foundation

Choose Your Foods: Exchange Lists for Diabetes (formerly Exchange Lists for Meal Planning) , a booklet used to help people with diabetes plan meals, has been in existence for more than 50 years. Planning for the fifth revision was guided by survey responses from >3,000 registered dietitians and other health professionals, current diabetes management and nutrition recommendations, and the food marketplace. In addition to a name change, major changes were made in design and overall readability. Changes within food groupings and the addition of a number of foods (mainly ethnic/regional) were accomplished while maintaining the well-recognized and accepted mean macronutrient and energy values of the basic lists. As with previous editions, this publication is intended as a resource for use by individuals with diabetes, with the guidance of a registered dietitian. This booklet is also intended to be used as a basis for nutrition educational materials developed by the American Dietetic Association and American Diabetes Association (eg, carbohydrate counting, weight management) and as a method for students and others to learn about diabetes meal planning. Practical guidelines for use of this updated resource for meal planning (eg, sugar alcohols, dietary fiber, and alcohol) are also presented.

During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on “Standards of Medical Care for Patients With Diabetes Mellitus” (last revised October 2003) included “special considerations” for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6). The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus (7). Several excellent detailed guidelines and chapters on type 1 diabetes in pediatric endocrinology texts exist, including those by the International Society of Pediatric and Adolescent Diabetes (ISPAD) (8), by the Australian Pediatric Endocrine Group (www.chw.edu/au/prof/services/endocrinology/apeg), in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13). Children have characteristics and needs that dictate different standards of care. The management of diabetes in children must take the major differences between children of various ages and …

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.

A large proportion of a home care nurse's caseload is elderly persons with diabetes, presenting as either a primary or secondary diagnosis. This article provides specific guidelines for nutritional knowledge and assessment of these clients while giving practical guidelines for nutrition counseling and education.

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.