Research Summary

Analyzed using Evidence Intelligence™

Nutrition education shows equivalent effects on glycemic control in type 1 diabetes

Last updated September 11, 2026

Key finding

There were no significant differences at 12 months in HbA1c; FBA versus RC (−0.4 mmol/mol (1.3), 0.04% (0.1%)).

This study evaluated the effects of a food-based approach, carbohydrate counting, and routine care on adults with type 1 diabetes. It found no significant differences in HbA1c levels after 12 months.

Quick read

Study at a glance

The essential study design details in one scan.

EvidenceScore™

Moderate

Study type

RCTs

Follow-up

Long-Term (1–5 y)

Risk of bias

Some Concerns

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Plain-language summary

What this paper says

A plain-language read of the study’s main message and where it applies.

Study focus

This study evaluated the effects of a food-based approach, carbohydrate counting, and routine care on adults with type 1 diabetes. It found no significant differences in HbA1c levels after 12 months.

Clinical relevance

Understanding effective dietary strategies for managing type 1 diabetes is crucial for improving patient outcomes. This study highlights that while dietary improvements can be achieved with a food-based approach, they may not directly translate into better blood sugar control, which is essential for long-term health.

Keep in mind

The study did not demonstrate significant changes in HbA1c levels. The sample size and demographic characteristics may limit generalizability. The long-term effects of dietary changes were not assessed beyond 12 months.

Published in

Journal Reference

Publication details and source links for this paper.

Sofia SI, Margareta BB, Björn E, et al. Nutrition education using a food-based approach, carbohydrate counting, or routine care in adults with type 1 diabetes: a randomized controlled trial. BMJ Open Diabetes Research & Care. 2021;9(1):e001971. doi:10.1136/bmjdrc-2020-001971

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Main Effects

FBA showed improved intake of legumes, nuts, and vegetables compared to CC and RC.

FBA reported higher intake of monounsaturated and polyunsaturated fats compared to RC.

No significant differences in HbA1c levels were found among the three groups at 12 months.

Evidence network

How this study fits

Understand where this research contributes within the broader evidence network.

Evidence Context

This study contributes evidence to Carbohydrate Counting (CC), Control: Routine Care, Food-based approach (FBA) and HbA1c, Consumption of nuts, Consumption of vegetables, and 3 more.

This study contributes evidence to

Intervention

Carbohydrate Counting (CC)

Outcome

HbA1c

Evidence topic

HbA1c Reduction

Primary intervention

Carbohydrate Counting (CC)

Primary outcomes

HbA1c
Consumption of nuts
Consumption of vegetables

Evidence topics

HbA1c Reduction

Primary intervention

Carbohydrate Counting (CC)

Primary outcomes

HbA1c Consumption of nuts Consumption of vegetables

Evidence relationships

Intervention and outcome relationships this study adds to the evidence network.

Evidence pairs

Relationships

Evidence topics

contributes_evidence

Editorial context

Why this study matters

See why this paper is useful beyond its individual results.

Evidence network role

This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.

Moderate contributionModerate confidenceNetwork score: 59

Why it is useful

Contributes to 8 evidence relationships
Includes primary outcome data
Linked to 1 direct semantic evidence topic

Topic contributions

Evidence topic

Contributes evidence

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Primary evidence

Evidence topic

HbA1c Reduction

matched_outcome

Core evidence

Study findings

The primary outcomes reported in this study.

HbA1c

Carbohydrate Counting (CC) → HbA1c

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

HbA1c

Control: Routine Care → HbA1c

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Consumption of nuts

Food-based approach (FBA) → Consumption of nuts

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Consumption of vegetables

Food-based approach (FBA) → Consumption of vegetables

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

HbA1c

Food-based approach (FBA) → HbA1c

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Intake of legumes

Food-based approach (FBA) → Intake of legumes

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Polyunsaturated fatty acid intake

Food-based approach (FBA) → Polyunsaturated fatty acid intake

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Reported intake of monounsaturated fat

Food-based approach (FBA) → Reported intake of monounsaturated fat

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Evidence Library

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Evidence Suggest

FBA improved dietary intake of healthy foods without affecting HbA1c levels.
No significant HbA1c differences were observed between FBA, CC, and RC.
FBA led to higher consumption of beneficial fats compared to routine care.

Who this applies to

Adults diagnosed with type 1 diabetes.
Individuals seeking dietary management strategies for diabetes.

Keep in Mind

The findings may not apply to populations outside the study's demographic.
The lack of significant HbA1c change suggests dietary improvements alone may not suffice for blood sugar control.
Further research is needed to explore long-term effects of dietary interventions.

Between the Lines

The study did not demonstrate significant changes in HbA1c levels.
The sample size and demographic characteristics may limit generalizability.
The long-term effects of dietary changes were not assessed beyond 12 months.

Evidence Library

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Connected Evidence

Explore related studies, evidence collections, and research questions.

Relationships organized using the Dediabetes Evidence Intelligence™ framework.

This study contributes to evidence on Carbohydrate Counting (CC) and HbA1c, Control: Routine Care and HbA1c.

Related evidence relationships

Explore in Evidence Explorer

This study contributes to the evidence on the following intervention-outcome relationships.

Behavioral & Lifestyle

Detailed evidence

Carbohydrate Counting (CC) → HbA1c

Behavioral & Lifestyle

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

View evidence

Control

Detailed evidence

Control: Routine Care → HbA1c

Control

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

View evidence

Included in these evidence collections

Curated evidence collections and hubs this study is part of.

Carbohydrate Counting (CC) Evidence Hub

All studies on Carbohydrate Counting (CC)

1 studies

intervention_hub

Contributes to Carbohydrate Counting (CC) evidence base.

Control: Routine Care Evidence Hub

All studies on Control: Routine Care

1 studies

intervention_hub

Contributes to Control: Routine Care evidence base.

HbA1c Evidence Hub

All studies measuring HbA1c

1 studies

outcome_hub

Measures HbA1c as a key outcome.

Explore more in Evidence Explorer

Jump to pre-filtered views in Evidence Explorer.

All studies on Carbohydrate Counting (CC) and HbA1c

Intervention: Carbohydrate Counting (CC)Outcome: HbA1c

1 results

All studies on Control: Routine Care and HbA1c

Intervention: Control: Routine CareOutcome: HbA1c

1 results

All studies on Carbohydrate Counting (CC)

Intervention: Carbohydrate Counting (CC)

1 results

All studies on Control: Routine Care

Intervention: Control: Routine Care

1 results

All studies measuring HbA1c

Outcome: HbA1c

1 results

Questions answered by this study

Generated from the study's connected evidence using Evidence Intelligence™.

Does Food-based approach (FBA) improve consumption of nuts?

Emerging Evidence

Food-based approach (FBA) appears to improve consumption of nuts.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Consumption of nuts
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.

View Full Evidence

Does Food-based approach (FBA) improve consumption of vegetables?

Emerging Evidence

Food-based approach (FBA) appears to improve consumption of vegetables.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Consumption of vegetables
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.

View Full Evidence

Does Food-based approach (FBA) improve intake of legumes?

Emerging Evidence

Food-based approach (FBA) appears to improve intake of legumes.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Intake of legumes
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.

View Full Evidence

Does Food-based approach (FBA) improve polyunsaturated fatty acid intake?

Emerging Evidence

Food-based approach (FBA) appears to improve polyunsaturated fatty acid intake.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Polyunsaturated fatty acid intake
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.

View Full Evidence

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Next steps

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Evidence topics

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HbA1c Reduction Evidence Hub

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All studies on Carbohydrate Counting (CC) and HbA1c All studies on Control: Routine Care and HbA1c All studies on Food-based approach (FBA) and HbA1c All studies on Food-based approach (FBA) and Consumption of nuts

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