It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.

Latino (n = 10) and Caucasian (n = 8) clients with type 2 diabetes receiving care at a community health clinic participated in individual in-depth interviews assessing diabetes dietary self-management goal behaviors. Themes from interviews were identified using content analysis, which revealed current and future goals, influencing factors, and motivators and barriers to dietary modification for diabetes management. Implications for practice include simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the patient, in a socially supportive environment. Results contribute to future survey development and understanding how to optimize diabetes education for these populations.

BackgroundType 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.ObjectiveThe purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient–provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.Research design and methodsParticipants were rural or urban adult caregivers of youth ages 2–18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2 tests, as appropriate.ResultsCompared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient–provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.ConclusionsThe burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.

SummaryObjectiveACT! (Actively Changing Together) is a family‐ and community‐based intervention targeting youth with obesity. The objective of this study was to establish the longitudinal impact on Health‐Related Quality of Life (HRQoL) as well as the relationship with anthropometric and demographic factors.MethodsYouth (n = 75) aged 8–14 years meeting criteria for overweight or obesity were referred to the programme. Twelve, 90‐min classes in English and Spanish were held at the YMCA. Demographics and anthropometrics were assessed, as well as HRQoL that was measured with the child‐reported Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scale. Data was collected at three follow‐up points after completion of the intervention: initial follow‐up (n = 65), 6 (n = 41) and 12 months (n = 25). Analysis included paired dependent t‐tests between baseline and follow‐up, and Pearson's correlations on HRQoL, anthropometric and demographic data.ResultsPedsQL scores significantly improved from baseline to all follow‐up timepoints (initial follow‐up immediately following the intervention, and 6 and 12 months post intervention). Over time, body mass index Z‐Score and per cent body fat displayed various points of significance and strengthening correlations.ConclusionsLongitudinal improvements in HRQoL were sustained up to 12 months following a family‐ and community‐based intervention in this underserved population. Anthropometric measures continuously correlated with and contributed to HRQoL outcomes.

The purpose of this study was to identify goal setting education practices used by diabetes educators working with type 2 diabetes patients.