Interactive Nutrition Education Is More Effective in Terms of Improved Levels of Glycated Hemoglobin in Adolescent Patients with Poorly Controlled Type 1 Diabetes - A Randomized Study

Virtual Reality Meets Diabetes

BACKGROUND

This article provides a detailed summary of virtual reality (VR) and augmented reality (AR) applications in diabetes. The purpose of this comparative review is to identify application areas, direction and provide foundation for future virtual reality tools in diabetes.

METHOD

Features and benefits of each VR diabetes application are compared and discussed, following a thorough review of literature on virtual reality for diabetes using multiple databases. The weaknesses of existing VR applications are discussed and their strengths identified so that these can be carried forward. A novel virtual reality diabetes tool prototype is also developed and presented.

RESULTS

This research identifies three major categories where VR is being used in diabetes: education, prevention and treatment. Within diabetes education, there are three target groups: clinicians, adults with diabetes and children with diabetes. Both VR and AR have shown benefits in areas of Type 1 and Type 2 diabetes.

CONCLUSIONS

Virtual reality and augmented reality in diabetes have demonstrated potential to enhance training of diabetologists and enhance education, prevention and treatment for adults and children with Type 1 or Type 2 diabetes. Future research can continually build on virtual and augmented reality diabetes applications by integrating wide stakeholder inputs and diverse digital platforms. Several areas of VR diabetes are in early stages, with advantages and opportunities. Further VR diabetes innovations are encouraging to enhance training, management and treatment of diabetes.

Patient Characteristics Associated With Annual Nutrition Visits in Children With Type 1 Diabetes

Objective

Diabetes organizations recommend nutrition education by a registered dietitian (RD) at least annually following type 1 diabetes (T1D) diagnosis in children. The study objectives were to describe differences over time in annual RD follow-up in children with T1D and to identify patient characteristics associated with RD engagement.

Research Design and Methods

Data based on 6034 completed diabetes medical visits among 1982 patients aged <18 years with T1D for ≥1 year followed at a pediatric, tertiary care, academic medical center over a 5-year period (2018-2022) were analyzed. Generalized estimating equations models assessed for differences over time in the rates of RD visit completion in the year preceding the last diabetes medical encounter and identified sociodemographic, diabetes care-related, and clinical patient characteristics associated with RD follow-up. Models were fit for the whole sample and groups subset by race and ethnicity.

Results

Observed annual RD follow-up rate over the 5-year period was 20.8%, with the lowest adjusted percentage in 2021 compared to 2018. In multivariable analysis, for each year increase in age (p = 0.004) and diabetes duration (p<0.001), there was a 3% and 15% reduction in the odds of RD follow-up, respectively. RD follow-up was associated with lower hemoglobin A1c within the subsequent year in adjusted analysis (p = 0.029), with the greatest improvement among Hispanic patients.

Conclusions

Annual RD visit frequency among children with T1D is suboptimal. Study findings provide insights for targeted intervention to improve RD engagement. RD follow-up may be associated with improved glycemic outcomes.

Factors influencing nutrition literacy in patients of colorectal cancer: a cross-sectional study

Background

Colorectal cancer (CRC) patients often experience varying degrees of malnutrition both pre-and post-treatment, highlighting the importance of their nutritional knowledge. However, studies on nutrition literacy (NL) in this population remain scarce. This study aims to evaluate the level of NL in colorectal cancer patients and identify key factors influencing NL.

Methods

A total of 245 colorectal cancer patients participated in this study. The questionnaire included five sections: sociodemographic information, the Chinese Version of the Nutrition Literacy Assessment Instrument (CHI-NLit), the Montreal Cognitive Assessment Scale (MoCA), and the Hospital Anxiety and Depression Scale (HADS). Both univariate and multivariate analyses were performed to examine sociodemographic determinants of NL. We used Pearson and Spearman correlation coefficients to assess relationships between NL, MoCA and HADS.

Results

The overall NL level among CRC patients was moderately low, with an average score of 19.224 ± 4.391-significantly below the normative neutrophil score of 21.5. Among the assessed dimensions, food groups received the lowest scores while food label calculation achieved the highest. Significant predictors influencing NL levels included age, years of education, family annual income, in review duration of illness, number of hospitalizations, memory and attention abilities and anxiety and depress symptoms.

Conclusion

This study provides a comprehensive examination of NL in CRC patients. The findings indicate a relatively low level of NL within this group. Younger age, higher income levels, and urban residency correlated positively with elevated NL. Factors such as illness duration, number of hospitalizations, cognitive function measured by relevant scales are also emerged as significant determinants impacting NL. To enrich the research on NL, it is essential to conduct further data collection. From a clinical perspective, this evidence-based framework enables the development of stratified nutritional intervention protocols, specifically targeting vulnerable subgroups (e.g., elderly patients, rural dwellers, and those with extended illness duration). Such precision approaches hold significant potential to optimize dietary adherence, mitigate treatment-related complications, and ultimately enhance long-term quality of life in cancer survivorship care.

Low-carbohydrate diet proved effective and safe for youths with type 1 diabetes: A randomised trial

AIM

Low-carbohydrate (LC) diets have gained popularity. We compared glycaemic and metabolic parameters following an LC versus a Mediterranean (MED) diet in adolescents and youths with type 1 diabetes.

METHODS

In a six-month, open-label, randomised trial, 40 individuals were assigned to either diet. Glycaemic outcomes, based on continuous glucose monitoring, included per cent time of blood glucose in the range [3.9-10.0 mmol/L (70-180 mg/dL)] and haemoglobin A1c (HbA1c).

RESULTS

Twenty-eight (70%) were females. The median age was 18 years. After 6 months, the median time in range increased from 47% to 58% in the LC and from 52% to 64% in the MED diet group (p = 0.98). The delta values for the time in range were 16% and 7% for the respective groups (p = 0.09). The percentage of time >13.9 mmol/L (>250 mg/dL) improved more in the LC diet than in the MED diet group: -10% vs. -2% (p = 0.005). The percentage of time <3.0 mmol/L (<54 mg/dL) was comparable. The delta HbA1c improved in both groups: -0.7% vs. -0.1% (p = 0.02). Changes in BMI Z-score and lipid levels were similar.

CONCLUSION

Both diets improved glycaemic outcomes in adolescents and youths with type 1 diabetes, without increasing hypoglycaemia or cardiovascular risk factors, indicating comparable safety and efficacy.

Health Promotion in Glycemic Control and Emotional Well-Being of People with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Structured therapeutic patient education is the key to improving biopsychosocial outcomes in people with type 1 diabetes mellitus. This study aimed to determine the effects of structured therapeutic education on glycemic control and emotional well-being in people with type 1 diabetes mellitus.

METHODS

This is a systematic review with a meta-analysis (PROSPERO ID: CRD42023390079). Searches were performed in Scopus, MEDLINE, Web of Science, CINAHL, APA PsycInfo, APA PsycArticles, and the Psychology Database (June-August 2024). The eligibility criteria included randomized controlled trials published in English or Spanish within the past 10 years. Data extraction and risk of bias evaluations were independently conducted by two reviewers. The outcomes analyzed included glycated hemoglobin, time in range, emotional well-being, self-management behaviors, and adherence to treatment. Meta-analyses were performed using RevMan with random and fixed effects models.

RESULTS

Seventeen studies met the eligibility criteria. There was a significant improvement in glycemic control, stress, anxiety, and treatment satisfaction, although the results for the other emotional outcomes were mixed.

CONCLUSIONS

Structured therapeutic patient education improves glycemic control and selected emotional outcomes in individuals with type 1 diabetes mellitus. Further trials are needed to refine the characteristics of the intervention and broaden the applicability of the findings to diverse populations.

Nutrition Literacy: What Are Young Adults With Type-1 Diabetes Missing?

INTRODUCTION

This study evaluated the nutrition literacy and perceived emotional burden of disease in young adults with type-1 diabetes. All participants are current or past members of the non-profit organization The Diabetes Link, formally known as the College Diabetes Network. The Diabetes Link is a 501(c)(3) nonprofit organization working to connect and support young adults with type-1 diabetes through the transitional periods of their lives, most commonly the transition from high school to college. Previous research shows that there is a significant uptick in glycated hemoglobin (HbA1c) levels in people with type-1 diabetes between the ages of 18 and 24, a period associated with many transitional events. While there are numerous hypothesized reasons why HbA1c levels spike during these ages, the lack of nutritional knowledge is frequently highlighted as a root cause of this increase.

METHODS

Participants were asked to complete a 40-question survey via Google Forms (Google LLC, Mountain View, California, United States) that contained questions pertaining to their treatment, dietary habits, confidence in healthcare professionals to provide nutrition advice, and overall feelings toward their diagnosis of type-1 diabetes. The survey also included four questions aimed at evaluating the participants' carbohydrate-counting skills to determine a basis of their nutritional knowledge. A binary logistic regression was performed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) to assess the influences of the burden and carbohydrate-counting knowledge on the participants' diabetes care, eating habits, and emotional outlook on nutrition.

RESULTS

Data from this study show that the participants who scored high on the carbohydrate-counting quiz were 2.389 times more likely to avoid eating because of an out-of-range blood sugar level (p-value = 0.05), and the participants who reported higher levels of burden were 9.325 times more likely to avoid social gatherings because of food (p-value = 0.002).  Conclusion: Results from this study demonstrate that the emotional burden associated with eating and not nutrition knowledge could contribute to the previously listed spike in HbA1c levels.

Transition From Pediatric to Adult Care for Individuals With Type 1 Diabetes: Opportunities and Challenges

OBJECTIVES

Type 1 diabetes (T1D) is a chronic disease with patients across the age spectrum that has high potential for morbidity and mortality. Unfortunately, patients transitioning from pediatric to adult care continue to demonstrate worsened glycemic control in part due to lack of understanding of transition of care best practices.

METHODS

This review highlights the impact of existing transition of care interventions, assessment tools, and other recently published strategies for providers to consider to improve care of adolescent and young adult (AYA) patients with T1D in both hospital- and clinic-based settings.

RESULTS

Many barriers impact patients with T1D during the transition period and disparities by race, sex, insurance status, and comorbid illness persist. As diabetic care continues to evolve and the prevalence of adolescents and young adults living with T1D increases, an intentional approach to transition of care is more pressing than ever. While current literature on transition of care models is limited, many show promise in improving clinic attendance and decreasing hospitalization. There are critical discussions that providers should lead with AYA patients to improve their outcomes and increase diabetes self-management, such as re-addressing carbohydrate counseling, sleep hygiene, and reproductive planning.

CONCLUSION

While further research on transition of care is needed, many care models offer the promise of improved T1D outcomes, enhancements in our approach to care, and increased value for our health care system at large.

A Brief Nutrition Questionnaire for Children With Newly Diagnosed Type 1 Diabetes

Carbohydrate counting is an important component of type 1 diabetes management that is taught at the time of diagnosis. We implemented and validated a nutrition quiz to assess fundamental carbohydrate counting and nutrition knowledge in newly diagnosed patients. An interactive standard assessment for newly diagnosed type 1 diabetes patients was feasible and reliable to implement for patients and caregivers, but participants with public insurance scored lower overall. This assessment may help to identify nutrition knowledge gaps and provide opportunities for timely education, and providers should place additional focus on nutrition education for patients with public insurance.

Brief Pictorial Quizzes to Assess Carbohydrate Counting and Nutrition Knowledge in Youth With Type 1 Diabetes

Available assessments of patient nutrition knowledge and carbohydrate counting ability are lengthy. This article reports on a study to implement and validate a series of brief nutrition quizzes of varying difficulty for use in pediatric type 1 diabetes. Among 129 youth with type 1 diabetes, participants completed an average of 2.4 ± 1 of the six quizzes, with a median score of 4.7 of 5. Higher quiz scores were associated with lower A1C (P <0.001), higher parental education (P = 0.02), and higher income (P = 0.01). Such quizzes can help to identify knowledge gaps and provide opportunities for education, which may improve glycemic outcomes in youth with type 1 diabetes.

Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review

BACKGROUND

Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment.

OBJECTIVES

Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes.

METHODS

The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance.

RESULTS

From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI.

CONCLUSIONS

Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.