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The Diabetes Education Study (DIABEDS) was a randomized, controlled trial of the effects of patient and physician education. This article describes a systematic education program for diabetes patients and its effects on patient knowledge, skills, self-care behaviors, and relevant physiologic outcomes. The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center. Patients were predominantly elderly, black women with non-insulin-dependent diabetes mellitus of long duration. Patients randomly assigned to experimental groups (N = 263) were offered up to seven modules of patient education. Each content area module contained didactic instruction (lecture, discussion, audio-visual presentation), skill exercises (demonstration, practice, feedback), and behavioral modification techniques (goal setting, contracting, regular follow-up). Two hundred seventy-five patients remained in the study throughout baseline, intervention, and postintervention periods (August 1978 to July 1982). Despite the requirement that patients demonstrate mastery of educational objectives for each module, postintervention assessment 11-14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge. However, statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous. Experimental group patients experienced significantly greater reductions in fasting blood glucose (-27.5 mg/dl versus -2.8 mg/dl, P less than 0.05) and glycosylated hemoglobin (-0.43% versus + 0.35%, P less than 0.05) as compared with control subjects. Patient education also had similar effects on body weight, blood pressure, and serum creatinine. Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization.

OBJECTIVE -To determine, for individuals with type 2 diabetes and microalbuminuria, the effects of 6 weeks of meals containing plant-based protein (PP) versus meals with predominantly animal-based protein (AP) on renal function and secondarily on glycemia, lipid levels, and blood pressure.RESEARCH DESIGN AND METHODS -In a randomized crossover trial, we compared 6 weeks of meals containing only PP with meals containing primarily AP (60% animal, 40% plant) in 17 subjects with type 2 diabetes and microalbuminuria treated with diet and/or oral antidiabetic agents. Protein content was equivalent to the average American diet, and calories provided weight maintenance. Nutrients were equivalent between the two diets. Meals were prepared and packaged by a metabolic kitchen staff and were sent home weekly. At the beginning and end of each 6-week period, subjects were studied for 36 h on a metabolic unit.RESULTS -There were no significant differences between diets for glomerular filtration rate, renal plasma flow, albumin excretion rate, total cholesterol, HDL cholesterol, triglyceride area under the curve (AUC), glucose and insulin AUC, HbA 1c, blood pressure, or serum amino acids. For both diets, at the end of the treatment periods as compared with baseline, total cholesterol was significantly lower (PP and AP: from 4.75 to 4.34 mmol/l, P Ͻ 0.01), HbA 1c had significantly improved (PP: from 8.1 to 7.5%, P Ͻ 0.01; AP: from 7.9 to 7.4%, P Ͻ 0.01), and diastolic blood pressure was significantly lower (PP: from 83 to 80 mmHg, P Ͻ 0.02; AP: from 82 to 78, P Ͻ 0.02).CONCLUSIONS -There is no clear advantage for the recommendation of diets containing only PP rather than diets containing protein that is primarily animal-based for individuals with type 2 diabetes and microalbuminuria. There are, however, potential lipid, glycemic, and blood pressure benefits for following a carefully constructed, weight-maintaining, healthy diet, regardless of protein source. Diabetes Care 25:1277-1282, 2002O ne of the risk factors in type 2 diabetes for progression to diabetic nephropathy, renal failure, and early cardiovascular morbidity and mortality (1-6) is microalbuminuria. Therapies that reverse or delay the progression of microalbuminuria include normalization of blood pressure with ACE inhibitors (7) and angiotensin II receptor blockers (8) and improved blood glucose control (9,10). More problematic is the effectiveness of reducing the amount of dietary protein to at least 0.8 -1.0 g ⅐ kg body wt Ϫ1 ⅐ day Ϫ1 (11) or changing the type of protein. Studies performed in normoalbuminuric individuals with diabetes have suggested that changing the composition of the diet by altering the source of protein from animal to plant, either acutely in the setting of a standard test meal (12) or for up to 4 weeks (13), might produce beneficial renal effects. However, in another acute study, individuals with type 1 or type 2 diabetes and microalbuminuria showed no significant change in renal function when given plant-based protein (PP) versus animal-based...