Educating patients with diabetes: comparison of nutrient-based and exchange group methods

This study compared the effectiveness of a nutrient-based (diet guide) approach with that of a food-group (exchange lists) approach to menu planning for persons with noninsulin-dependent diabetes. Each method was presented to four groups in three-session workshops emphasizing meal planning to reduce risk of heart disease. The diet guide method evaluated menus specifically for calories, source of calories, cholesterol, fiber, sodium, and key vitamins and minerals. Of 105 subjects recruited, 97 completed the workshops and 83 the 6-month follow-up. Subjects responded positively to the diet guide method, finding it as easy to use as the exchange lists method. Menu planning and evaluation initially took longer using the diet guide than the exchange group method (25 vs. 16 minutes per day), but subjects indicated that time was well spent. Also, with practice, the time required to use the diet guide method decreased to 17 minutes per day. Both diet-education programs improved attitude and knowledge regarding diabetes, diet, and nutrition, with retention of knowledge gained for up to 6 months. Increases in applied nutrition knowledge scores were significantly greater, however, for diet guide than for exchange lists subjects both 3 months (24% vs. 15% increase) and 6 months postworkshop (15% vs. 8% increase). We conclude that the diet guide method can effectively serve as an alternative menu-planning system to exchange lists for patients with noninsulin-dependent diabetes who have at least a high school education.