Key result
Nutrition education and food security interventions fail to improve Diabetes Plate Index scores in T2D.
Why the study?
The Diabetes Plate is widely used for nutrition education in type 2 diabetes, but no standardized metric exists to quantify adherence to its recommendations.
Does ADA's What Can I Eat? (WCIE) nutrition education curriculum with or without food security resources improve Diabetes Plate Index scores in adults with type 2 diabetes?
RCT (n=67)
randomized
Does ADA's What Can I Eat? (WCIE) nutrition education curriculum with or without food security resources improve Diabetes Plate Index scores in adults with type 2 diabetes?
p-value: p=not significant
A pilot RCT demonstrated the feasibility of deriving a Diabetes Plate Index to quantify dietary adherence, though a 12-week nutrition and food security intervention did not significantly change scores in adults with T2D.
No benefit on dietary adherence from 12-week nutrition education with or without food resources; leaves open need for longer or intensified interventions in type 2 diabetes.
Introduction and Objective: The ADA’s Diabetes Plate (DP) is widely used to guide nutrition education for people living with type 2 diabetes (T2D), offering a simple visual framework for structuring balanced meals. However, there is currently no standardized metric to quantify adherence to DP recommendations. This study seeks to develop and evaluate a DP Index (DPI) as a new tool to measure DP adherence. Methods: Data were drawn from a pilot three-arm randomized controlled trial of ADA’s What Can I Eat? (WCIE) nutrition education curriculum among 67 adults living with T2D randomized to WCIE+ food security resource (FSR), WCIE alone, or FSR alone for 12 weeks. Participants completed two RDN-administered 24-hour recalls at baseline and two at 12 weeks (one scheduled, one unannounced at each timepoint). Meals were coded for adherence (0/1) to DP components: non-starchy vegetables, protein, carbohydrates, and beverage type. Scores were summed across meals to create a DPI for each recall and averaged per participant. Higher DPI indicate greater DP adherence. We compared DPI scores by treatment arm at pre and post using Kruskal-Wallis tests and assessed within-person change using Wilcoxon signed-rank tests. Results: Mean baseline DPI did not differ by arm (FSR Only: 8.2 ± 2.9; WCIE Only: 8.6 ± 2.1; WCIE+FSR: 8.5 ± 2.6), and no significant between- or within-group changes were detected at follow-up. Mean changes in DPI from baseline to 12 weeks ranged from -0.5 to -1.1, reflecting generally stable DP adherence across groups and over time. Conclusion: This pilot study demonstrates the feasibility of deriving a DPI as a quantitative measure of DP adherence. The DPI offers a structured approach for evaluating DP-focused nutrition interventions and may support more precise assessment of dietary behavior change in future research. Disclosure L.E. Hebert: None. S.A. Stotz: None. K. Begay: None. T. Hicks: None. S. Palmer: None. I. Barry: None. M. Coca: None. D. Hanumanula: None. S. Krawczyk: None. M. Dennison: None. N. Begick: None. A. Trice: None. S. Berkowitz: Research Support; Current; Blue Cross Blue Shield North Carolina. L. Jiang: None. S.M. Manson: None. C. Byker Shanks: None. Funding American Diabetes Association (11-22-ICTSN-10), National Institutes of Health (K01DK128023)
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HEBERT et al. (2026) conducted an RCT in Type 2 diabetes (n=67). What Can I Eat? (WCIE) nutrition education curriculum + food security resource (FSR) vs. WCIE alone or FSR alone was evaluated on Change in Diabetes Plate Index (DPI) score from baseline to 12 weeks (p=not significant). A nutrition education and food security intervention did not significantly change Diabetes Plate Index scores at 12 weeks among adults with type 2 diabetes.
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