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Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions.

Current controversies for medical nutrition therapy in pregnancies complicated by diabetes include the composition and amount of carbohydrates and fats as well as optimal gestational weight gain and energy restriction. Although carbohydrate is the macronutrient with the greatest effect on glycemic control, there is little evidence for a recommended amount and type of carbohydrate or its distribution. This lack of evidence prompts an issue of debate among practitioners over the type of carbohydrate and its percent distribution throughout the day. The best indicators at this time are the results of self-monitoring of blood glucose, ketone testing, food records, and weight gain. A review of the literature provides the most current information available for medical nutrition therapy during a pregnancy complicated by diabetes and reinforces the need for further research in the form of randomized controlled trials to answer questions regarding carbohydrate modification and distribution, energy needs, and weight gain.

In Brief Disturbed eating behaviors are common in adolescent girls and young women; however, these behaviors are significantly more common in those with type 1 diabetes than in the general population. Long-term treatment of patients with eating disorders and type 1 diabetes (ED-DMT1) often occurs in outpatient settings. This article reviews the clinical issues and strategies relevant to the outpatient treatment of ED-DMT1.

ObjectiveTo report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.DesignA four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.SettingA large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.SubjectsFifty-eight households, with at least one child living in the home.ResultsDuring the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.ConclusionsAt baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

PurposeThis article shares an innovative educational practice for increasing the knowledge base of direct-care registered nurses related to diabetes management. Outcome data include quantitative analysis of test scores, qualitative responses of changes in practice, and participation in monthly diabetes resource meetings.ConclusionDiabetes educators will find the DiaBEATes Nurse Champion program useful for structuring educational programs within various practice settings. The case studies are useful tools for evaluating specific application of diabetes knowledge.BackgroundThe nearly 24 million people with diabetes strain the health care system in terms of resources and health care dollars. According to the American Diabetes Association (ADA) a hospital stay for a patient with diabetes costs almost 3 times the stay of a patient without diabetes.1 The higher costs associated with caring for a patient with diabetes is partly attributed to inadequate knowledge regarding current diabetes treatment options and the failure of some health care workers to accept professional responsibility for diabetes management. 2,3