Implementation of Nutrition Assessments to Evaluate and Improve Nutrition Knowledge at Initial Follow-up of New-Onset Type 1 Diabetes

Background: Carbohydrate counting is a key component of type 1 diabetes (T1D) management that is taught at the time of diagnosis, but it is hard to determine how much knowledge is retained during that stressful period. We hypothesize that implementation of a nutrition quiz at one of the first comprehensive diabetes follow-up visits will evaluate knowledge retained and increase carbohydrate counting knowledge in newly diagnosed T1D patients. Methods: A quality improvement project was prospectively conducted to assess nutrition knowledge retained following new onset diagnosis of T1D. We implemented a 16-item nutrition assessment (at the 1st or 2nd outpatient visit), evaluating topics including nutrition label reading, hypoglycemia/hyperglycemia management, and insulin dose calculations. Data was collected from the medical record, and descriptive and summary statistics were performed. Results: Quizzes were administered to 17 patients/caregivers, mean age of patient 8.9y (SD=3.5), 83% NH White, mean HbA1c 9% at time of assessment, and mean time of 2.5 months from diagnosis. Quizzes were completed by parents 53%, parents and child 35%, and child 12% of the time. Mean overall quiz score was 13.5/16, with scores related to questions about insulin of 4.18/5, general nutrition of 3.24/4, nutrition labels of 1.65/2, and symptoms and complications of 4.41/5. The dietitian spent on average 20 min (range 13-30 min) with patient/caregiver. Patient age was not associated with quiz score. Patients with private insurance scored higher on the quiz compared to those with Medicaid (p = 0.05). Ongoing recruitment may further elucidate this association. Conclusions: Implementation of nutrition assessments is feasible and facilitates nutrition education with the patient and/or caregiver in an engaging manner. There is a vast amount of nutrition knowledge to be acquired at diagnosis of T1D, and reinforcement is important for long-term diabetes management and outcomes. Disclosure M. R. Thivierge: None. S. Snow: None. M. Seel: None. E. A. Brown: None. Y. Akhtar: None. R. Wolf: Consultant; Self; NEMA Research.