Background: Carbohydrate counting is used to determine prandial insulin doses in pediatric diabetes management. Benefits to carbohydrate counting include improved glycemic control, improved diabetes-specific quality of life, and improved coping ability in daily life. Patients self-report knowledge and comfort in carbohydrate counting, but we have no quantifiable way to determine the accuracy of this self-report. Thus, we implemented nutrition quizzes with photos of popular foods to assess fundamental knowledge of carbohydrate counting.

Methods: Pictorial nutrition quizzes were developed to review basic, intermediate and advanced fundamentals of carbohydrate counting. The nutritionist administered the quizzes to children >8 years of age, as part of regular outpatient diabetes follow-up visits. Children completed the quizzes independently and were allowed to use their insulin pump and phone to calculate insulin doses. Quiz responses and scores were recorded, in addition to visit hemoglobin A1c (HbA1c). Demographic and clinical data were extracted from the electronic medical record.

Results: Nutrition quizzes were completed by 103 youth (99 with T1D, 4 with T2). Mean age was 14.2 (SD 2.6), 44% female, 70% White, mean duration of diabetes 6 y (SD 4). 65% used insulin pumps, 68% used CGMs. All patients (n=103) completed 1 quiz, and 31 completed more than 1 quiz (range 2-5 quizzes). Patients with better glycemic control scored higher on nutrition quizzes. Mean A1c at initial quiz administration was 9%, and at follow-up was 8.6% (p=0.4).

Conclusion: Pictorial nutrition quizzes engage children and adolescents with diabetes in reviewing the fundamentals of carbohydrate counting and provide opportunity for nutrition intervention during routine diabetes clinical care.


M.R. Thivierge: None. M. Waheed: None. M. Seel: None. R. Wolf: None.

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