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Implementation and feasibility of a nutrition assessment for recently diagnosed youth with type 2 diabetes

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Published/Copyright: November 25, 2025
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 39 Issue 1

Abstract

Objectives

Nutrition education is important for managing type 2 diabetes (T2D), and how much knowledge is retained after nutrition education for new onset diabetes is challenging to assess. We hypothesize that deployment of a nutrition assessment will reinforce nutrition knowledge in newly diagnosed youth with T2D.

Methods

An exploratory quality improvement project was conducted to evaluate nutrition knowledge retained following new diagnosis of T2D. We implemented an 18-item nutrition assessment (at the first or second outpatient visit) evaluating nutrition label reading, hypoglycemia/hyperglycemia management, insulin management, and physical activity. Data was collected from the medical record, and descriptive and summary statistics were performed.

Results

Quizzes were administered to 19 patients and their caregivers, mean patient age 14.9 ± 2.1 years, 68 % female, 68 % NH Black, 79 % publicly insured, with mean HbA1c 11.3 % at diagnosis, and 8.2 % at time of assessment. Mean overall nutrition assessment score was 14/18 (76 %). Patients scored well on questions about insulin (87 % correct) and physical activity (90 % correct) but needed additional reinforcement on questions about general nutrition (61 % correct) and acute and chronic complications of diabetes (64 % correct). Patients who had a lower HbA1c at follow-up scored higher on the quiz (p=0.037). Dietitians commented that the assessments allowed them to gain “quick insight” into patients’ baseline knowledge, which enabled more tailored nutrition education with each patient.

Conclusions

Implementation of nutrition assessments during comprehensive diabetes visits is feasible and facilitates nutrition education with the patient and/or caregiver in an engaging manner. Reinforcement of nutrition education is critical for type 2 diabetes management and outcomes.

Keywords: type 2; diabetes; nutrition; quiz; assessment; youth; nutrition education
Corresponding author: Risa Wolf, MD, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, 21287 Baltimore, MD, E-mail:

  1. Research ethics: This study received approval from the Johns Hopkins Institutional Review Board with a waiver of consent.

  2. Informed consent: Not applicable as study was approved with a waiver of consent.

  3. Author contributions: R.M.W., M.T., and E.A.B. conceived of the study. D.P., C.W., M.T., A.B., and A.O., collected data. E.A.B. completed the statistical analyses and created the figures and tables. C.W., D.P., E.A.B, and R.M.W. wrote the manuscript. All authors made critical contributions to the manuscript. All authors edited, reviewed, and approved the manuscript. The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: R.M.W. receives research support as the site PI of sponsored clinical trials from Novo Nordisk, Lilly Diabetes and Sanofi. The other authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: Not applicable.

References

1. Nadeau, KJ, Anderson, BJ, Berg, EG, Chiang, JL, Chou, H, Copeland, KC, et al.. Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities. Diabetes Care 2016;39:1635–42. https://doi.org/10.2337/dc16-1066.Search in Google Scholar PubMed PubMed Central

2. Zeitler, P. Progress in understanding youth-onset type 2 diabetes in the United States: recent lessons from clinical trials. World J Pediatr 2019;15:315–21. https://doi.org/10.1007/s12519-019-00247-1.Search in Google Scholar PubMed

3. Consortium, R. Restoring Insulin Secretion (RISE): design of studies of beta-cell preservation in prediabetes and early type 2 diabetes across the life span. Diabetes Care 2014;37:780–8. https://doi.org/10.2337/dc13-1879.Search in Google Scholar PubMed PubMed Central

4. Patel, D, Shah, AS, Magella, B, Bahrainian, M, Brown, EA, Liu, TYA, et al.. High rate of complications in a real-world cohort of youth with T2D: a multicenter analysis. J Diabetes Complicat 2025;39:109091. https://doi.org/10.1016/j.jdiacomp.2025.109091.Search in Google Scholar PubMed PubMed Central

5. Hamman, RF, Bell, RA, Dabelea, D, D’Agostino, RBJr., Dolan, L, Imperatore, G, et al.. The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes Care 2014;37:3336–44. https://doi.org/10.2337/dc14-0574.Search in Google Scholar PubMed PubMed Central

6. Chadda, KR, Cheng, TS, Ong, KK. GLP-1 agonists for obesity and type 2 diabetes in children: systematic review and meta-analysis. Obes Rev 2021;22:e13177. https://doi.org/10.1111/obr.13177.Search in Google Scholar PubMed

7. Phelan, H, Lange, K, Cengiz, E, Gallego, P, Majaliwa, E, Pelicand, J, et al.. ISPAD Clinical Practice Consensus Guidelines 2018: diabetes education in children and adolescents. Pediatr Diabetes 2018;19:75–83. https://doi.org/10.1111/pedi.12762.Search in Google Scholar PubMed

8. Olefsky, JM, Kolterman, OG, Scarlett, JA. Insulin action and resistance in obesity and noninsulin-dependent type II diabetes mellitus. Am J Physiol 1982;243:E15–30. https://doi.org/10.1152/ajpendo.1982.243.1.E15.Search in Google Scholar PubMed

9. American Diabetes, A. 13. Children and adolescents: standards of medical care in diabetes-2021. Diabetes Care 2021;44:S180–99. https://doi.org/10.2337/dc21-S013.Search in Google Scholar PubMed

10. Waheed, M, Lin, T, Thivierge, M, Seel, M, Prichett, L, Brown, EA, et al.. Brief pictorial quizzes to assess carbohydrate counting and nutrition knowledge in youth with type 1 diabetes. Clin Diabetes 2022;41:141–6. https://doi.org/10.2337/cd21-0134.Search in Google Scholar PubMed PubMed Central

11. Tsai, S, Patton, S, DeLurgio, S, Williams, DD, Dileepan, K, Karmazin, A, et al.. A new paediatric diabetes knowledge test - M-WIKAD development and factor analysis. Eur Endocrinol 2019;15:1–5. https://doi.org/10.17925/EE.2019.15.1.1.Search in Google Scholar PubMed PubMed Central

12. Marker, AM, Noser, AE, Knecht, N, Clements, MA, Patton, SR. A time-friendly, feasible measure of nutrition knowledge in type 1 diabetes: the electronic nutrition and carbohydrate counting quiz (eNCQ). J Diabetes Sci Technol 2019;13:68–74. https://doi.org/10.1177/1932296818778608.Search in Google Scholar PubMed PubMed Central

13. Mauri, A, Schmidt, S, Sosero, V, Sambataro, M, Nollino, L, Fabris, F, et al.. A structured therapeutic education program for children and adolescents with type 1 diabetes: an analysis of the efficacy of the “Pediatric Education for Diabetes” project. Minerva Pediatr (Torino) 2021;73:159–66. https://doi.org/10.23736/S2724-5276.17.04634-5.Search in Google Scholar PubMed

14. Snow, S, Thivierge, M, Seel, M, Brown, E, Akhtar, Y, Wolf, RM. A brief nutrition questionnaire for children with newly diagnosed type 1 diabetes. Clin Diabetes 2022;41:192–7. https://doi.org/10.2337/cd22-0031.Search in Google Scholar PubMed PubMed Central

15. Rovner, AJ, Nansel, TR, Mehta, SN, Higgins, LA, Haynie, DL, Laffel, LM. Development and validation of the type 1 diabetes nutrition knowledge survey. Diabetes Care 2012;35:1643–7. https://doi.org/10.2337/dc11-2371.Search in Google Scholar PubMed PubMed Central

16. Speight, J, Bradley, C. The ADKnowl: identifying knowledge deficits in diabetes care. Diabet Med 2001;18:626–33. https://doi.org/10.1046/j.1464-5491.2001.00537.x.Search in Google Scholar PubMed

17. Breen, C, Ryan, M, Gibney, MJ, O’Shea, D. Diabetes-related nutrition knowledge and dietary intake among adults with type 2 diabetes. Br J Nutr 2015;114:439–47. https://doi.org/10.1017/S0007114515002068.Search in Google Scholar PubMed

Received: 2025-08-13
Accepted: 2025-11-10
Published Online: 2025-11-25
Published in Print: 2026-01-23

© 2025 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Prevalence of congenital hypothyroidism in infants of mothers with hypothyroidism: a meta-analysis
  4. Original Articles
  5. Pubertal characteristics, final height, and associated factors in patients with nonclassical congenital adrenal hyperplasia: a single center experience
  6. Serum α-Klotho and its association with testosterone in boys with central precocious puberty
  7. Bioelectrical impedance analysis and hormonal assessment in adolescents with pubertal gynecomastia
  8. The relationship between FSTL-1 (follistatin-related protein 1), FAM19A5 (family with sequence similarity 19, member A5) and CTRP-6 (C1q/TNF-related protein 6) levels and metabolic parameters in overweight children
  9. Role of hyperandrogenism on disordered eating behaviors in adolescents with PCOS and interplay with insulin resistance
  10. The impact of hepatic steatosis on epicardial adipose tissue in obese individuals
  11. Exploratory real-world experience with GLP-1 receptor agonists vs. metformin in youth with new-onset type 2 diabetes: a single-center retrospective study
  12. Characterization of monogenic diabetes among Sudanese children: a multi-center experience from a population with high consanguinity
  13. Short Communication
  14. Implementation and feasibility of a nutrition assessment for recently diagnosed youth with type 2 diabetes
  15. Case Reports
  16. Noonan syndrome and autoimmune hepatitis: patient report and literature review
  17. Adrenal oncocytoma: an unusual etiology of Cushing’s syndrome in an adolescent female
  18. Novel MCT8 mutation: diagnostic value of T3/T4 ratio
  19. Clinical insights of the TBX19 C.856 C>T variant: a case report and literature review on neonatal isolated ACTH deficiency
  20. Wolcott–Rallison syndrome due to a novel homozygous missense variation (p.Gly602Val) in the exon 11 of EIF2AK3 gene
https://doi.org/10.1515/jpem-2025-0540
Keywords for this article
type 2; diabetes; nutrition; quiz; assessment; youth; nutrition education

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Prevalence of congenital hypothyroidism in infants of mothers with hypothyroidism: a meta-analysis
  4. Original Articles
  5. Pubertal characteristics, final height, and associated factors in patients with nonclassical congenital adrenal hyperplasia: a single center experience
  6. Serum α-Klotho and its association with testosterone in boys with central precocious puberty
  7. Bioelectrical impedance analysis and hormonal assessment in adolescents with pubertal gynecomastia
  8. The relationship between FSTL-1 (follistatin-related protein 1), FAM19A5 (family with sequence similarity 19, member A5) and CTRP-6 (C1q/TNF-related protein 6) levels and metabolic parameters in overweight children
  9. Role of hyperandrogenism on disordered eating behaviors in adolescents with PCOS and interplay with insulin resistance
  10. The impact of hepatic steatosis on epicardial adipose tissue in obese individuals
  11. Exploratory real-world experience with GLP-1 receptor agonists vs. metformin in youth with new-onset type 2 diabetes: a single-center retrospective study
  12. Characterization of monogenic diabetes among Sudanese children: a multi-center experience from a population with high consanguinity
  13. Short Communication
  14. Implementation and feasibility of a nutrition assessment for recently diagnosed youth with type 2 diabetes
  15. Case Reports
  16. Noonan syndrome and autoimmune hepatitis: patient report and literature review
  17. Adrenal oncocytoma: an unusual etiology of Cushing’s syndrome in an adolescent female
  18. Novel MCT8 mutation: diagnostic value of T3/T4 ratio
  19. Clinical insights of the TBX19 C.856 C>T variant: a case report and literature review on neonatal isolated ACTH deficiency
  20. Wolcott–Rallison syndrome due to a novel homozygous missense variation (p.Gly602Val) in the exon 11 of EIF2AK3 gene
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