"Counting Carbs to Be in Charge": A Comparison of an Internet-Based Education Module With In-Class Education in Adolescents With Type 1 Diabetes.

Carbohydrate counting is an essential component of type 1 diabetes education but can be difficult for adolescents to learn. Because adolescents are avid users of technology, an Internet-based education module was compared with an in-class education session in terms of carbohydrate counting accuracy in adolescents with type 1 diabetes. Adolescent participants displayed increased carbohydrate counting accuracy after attending an in-class education session compared with an Internet-based education module. These results suggest that online education is best reserved as an adjunctive therapy to in-class teaching in this population.

Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial.

BACKGROUND: Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. OBJECTIVE: Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. METHODS: Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. RESULTS: Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. CONCLUSIONS: Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. TRIAL REGISTRATION: ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142.

Food Insecurity Screening Among Families of Children With Diabetes.

Little is known about screening in clinical settings for food insecurity (FI) among households of children with diabetes. This study evaluated the acceptability and feasibility of an FI screening initiative in a pediatric diabetes clinic that was implemented to help diabetes dietitian educators tailor management plans for families of children with type 1 or type 2 diabetes facing FI. The initiative comprised three validated screening questions, a care algorithm, a community resource handout, and a poster. In total, 50 families of children and adolescents aged 0-18 years with type 1 or type 2 diabetes were screened for FI. In-person semi-structured interviews combining open-ended and Likert-scale questions were conducted with 37 of the screened families and the three diabetes dietitian educators who conducted the screening. Perceived barriers and facilitators of the screening initiative were identified using content analysis, and Likert-scale questionnaires rated interviewees' comfort level with the screening questions. A reflective journal kept by an onsite research interviewer also facilitated the data interpretation process. Most families felt comfortable answering the screening questions. Families with FI appreciated the opportunity to express their concerns and learn about affordable food resources. However, ∼20% of these families described stigma and fear of judgment by clinicians if they screened positive for FI. Diabetes educators also felt comfortable with the screening questions but reported lack of time to screen all families and to follow-up with resources after a positive screen. A self-reported intake form was recommended to ensure that everyone is systematically screened. A standardized and respectful method of assessing FI could help clinicians better tailor treatment plans and support for families of children with diabetes who face FI. Based on these findings, similar FI screening initiatives should be implemented in other clinical settings as part of routine clinical practice.

Emerging practices supporting diabetes self-management among food insecure adults and families: A scoping review.

BACKGROUND: Food insecurity undermines a patient's ability to follow diabetes self-management recommendations. Care providers need strategies to direct their support of diabetes management among food insecure patients and families. OBJECTIVE: To identify what emerging practices health care providers can relay to patients or operationalize to best support diabetes self-management among food insecure adults and families. ELIGIBILITY CRITERIA: Food insecure populations with diabetes (type 1, type 2, prediabetes, gestational diabetes) and provided diabetes management practices specifically for food insecure populations. Only studies in English were considered. In total, 21 articles were reviewed. SOURCES OF EVIDENCE: Seven databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Medline, ProQuest Nursing & Allied Health Database, PsychInfo, Scopus, and Web of Science. RESULTS: Emerging practices identified through this review include screening for food insecurity as a first step, followed by tailoring nutrition counseling, preventing hypoglycemia through managing medications, referring patients to professional and community resources, building supportive care provider-patient relationships, developing constructive coping strategies, and decreasing tobacco smoking. CONCLUSION: Emerging practices identified in our review include screening for food insecurity, nutrition counselling, tailoring management plans through medication adjustments, referring to local resources, improving care provider-patient relationship, promoting healthy coping strategies, and decreasing tobacco use. These strategies can help care providers better support food insecure populations with diabetes. However, some strategies require further evaluation to enhance understanding of their benefits, particularly in food insecure individuals with gestational and prediabetes, as no studies were identified in these populations. A major limitation of this review is the lack of global representation considering no studies outside of North America satisfied our inclusion criteria, due in part to the English language restriction.

One potato, two potato, assessing carbohydrate counting accuracy in adolescents with type 1 diabetes.

BACKGROUND/OBJECTIVE: Carbohydrate (CHO) counting is a recommended daily practice to help manage blood glucose levels in type 1 diabetes. Evidence suggests that CHO estimates should be within 10 to 15 g of the actual meal for optimal postprandial blood glucose control. The objective of this study was to assess accuracy of CHO counting in adolescents with type 1 diabetes. METHODS: Adolescents (aged 12-18 years) with type 1 diabetes who self-identified as regular CHO counters were recruited from the SickKids Diabetes Clinic, Toronto, Canada. Adolescents completed the PedsCarbQuiz (PCQ) and estimated CHO content of test trays (three meals and three snack trays) that were randomly assigned. Analyses were conducted to identify factors associated with accuracy of counting and CHO counting knowledge (PCQ score). RESULTS: A total of 140 adolescents (78 females, mean age 14.7, SD = 1.8) participated. The average PCQ score was 81 ± 10%. Forty-two percent of adolescents were accurate in estimating meal trays (ie, within 10 g of the actual CHO content), 44% estimated inaccurately (within 10-20 g), while 14% were significantly inaccurate counters (>20 g variation). PCQ scores were higher in teens who CHO counted accurately than in those with significant inaccuracy (>20 g) (P < 0.05), and a longer duration of diabetes corresponded significantly with a lower PCQ score. No demographics correlated significantly with CHO counting accuracy. CONCLUSIONS: Less than half of the teens in our study were accurate CHO counters. These results indicate the need for regular clinical accuracy check and reeducation.