OBJECTIVE -To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA 1c levels in urban African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS -A total of 648 patients with type 2 diabeteswere randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires.RESULTS -At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA 1c (9.4%). Improvements in glycemic control over 6 months were significant (P Ͻ 0.0001) but similar in both groups: HbA 1c decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches.CONCLUSIONS -Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations. Diabetes Care 26:1719 -1724, 2003M inority groups have a high prevalence of type 2 diabetes (1-4). In the National Health and Nutrition Examination Survey III and BRFSS (Behavioral Risk Factor Surveillance System), the age-standardized prevalence of diabetes was 1.6-fold higher in African Americans than in Caucasians (5,6). The disproportionate frequency of diabetes in African Americans is especially impressive in women (4,7), even after correcting for the prevalence of obesity (4,8 -10). The problem of diabetes for African Americans is particularly striking above the age of 45 years, when the prevalence of diabetes in African Americans is almost twice that in Caucasians (11); diabetes is present in 29% of African Americans 65-74 years of age (5). It is especially alarming that the frequency of altered metabolism is rising even in younger African Americans; recent studies found the prevalence of impaired glucose tolerance to be 20% in a group with an average age of 34 years (12) and 8.6% in girls between 5 and 10 years old (13).Medical nutrition therapy is essential in preventing the development of diabetes (14 -16), and medical nutrition therapy is well recognized as a cornerstone of management in patients who have diabetes. Med...

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Abbreviations: (HbA1c) hemoglobin A1c, (NGO) nongovernmental organizationKeywords: air pollution, cold, diabetes, environment, heat, natural disasters AbstractMany reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed "geoenvironmental diabetology." Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.

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