Mary E. Kunkel, PhD, RD, FADA,*Department of Food Science and HumanNutrition, 224 Poole Agricultural Center,Clemson University, Clemson, SC29634-0371;Tel: (864) 656-5690;Fax: (864) 656-0331; E-mail:bkunkel@clemson.eduBarbara Luccia, PhD, RD, NationalHealthcare—Greenville, Greer, SC

( J Nutr Educ Behav. 2004;36:157-158.)

*Author for correspondence

INTRODUCTION

Management of type 2 diabetes is acomplicated medical issue and requiresthe involvement of physicians, nurses,registered dietitians, pharmacists, andexercise specialists. However, there aresome concepts that Cooperative Ex-tension nutrition educators (agents)and nutrition educator assistants (para-professionals) can teach. The curricu-lum From the Pyramid to the Plate:Healthy Eating by Timing, Combining,and Planning is designed to instructlimited-resource clients with type 2diabetes who are controlling theirblood glucose by modifying diet andperhaps taking oral medications. Theobjective of this report is to describethe pilot programming of the curricu-lum with educators.

PROGRAM DESCRIPTION

The goals of the curriculum are to es-tablish a basic understanding of the re-lationship between diabetes and nutri-tion, to improve recognition of thefood groups and increase awareness ofthe importance of combining foodsfor improved diabetes control, and toimprove diabetic meal planning skillsusing the Food Guide Pyramid andplate recognition.The objectives of thecurriculum are to select a balancedcombination of foods based on theFood Guide Pyramid, time meals sothat blood glucose is more likely tostay within normal limits, plan practi-

cal meals, and develop an appropriateshopping list. Materials include 3scripted lesson plans (The Food GuidePyramid, Plate Recognition, and MealPlanning and Shopping List), a flipchart illustrating the lesson, a 15-ques-tion pre- and posttest, a videotapeteaching appropriate food combiningand plate recognition, handouts (in-cluding a meal planning form, recipes,and the Food Guide Pyramid), and acopy of Diabetes A to Z1 and DiabetesMeal Planning Made Easy2 for educatorreference. Food models were used forserving size demonstration.

PROGRAM EVALUATION

Educators were trained in the entirecurriculum during a day-long session.Training mirrored curriculum presen-tation to clients.The test was adminis-tered at the beginning and end of thetraining session (Table). Educators sig-nificantly increased their correct an-swers for 7 questions and demon-strated improved knowledge of mealplanning, shopping list preparation, ap-propriate snacking, and food groupidentification.Two questions were an-swered incorrectly by significantlymore educators in the posttest com-pared with the pretest. This reflectsmisunderstanding of foods containingcarbohydrate such as honey, milk, andjuice.

One year following training, a sur-vey was mailed to all educators (n =75) to determine curriculum use andeffectiveness. Of the 32 (43%) educa-tors who returned surveys, 20 (63%)had used the curriculum in a variety ofsettings, including senior centers, com-munity centers, homes, and diabetesclinics, directly contacting over 400clients.The educators reported that allcomponents of the curriculum wereuseful, particularly the flip chart,videotape, and reference books.Whereas some responded that thetraining session was very helpful andgave them the confidence to teach thecurriculum, others expressed a desirefor another review of the curriculum.The educators reported that com-ments from clients had been positiveand that clients reported increasedknowledge of meal planning and por-tion control. Of the 12 educators whohad not yet used the curriculum, 8 re-

ported intention to use the curricu-lum in the future. It is possible thatthey felt intimidated by the subjectmatter, did not feel adequately trainedin the curriculum, or did not haveclients with diabetes. Eight educatorshad not used the curriculum at thetime the surveys were returned buthad classes planned at senior centers,diabetes clinics, Department of SocialServices offices, and churches.

SUMMARY

From the Pyramid to the Plate: HealthyEating by Timing, Combining, and Plan-ning is unique in that it teaches lim-ited-resource clients how to translatethe Food Guide Pyramid to a practi-cal and realistic eating plan. Trainingnutrition educators is an importantstrategy to convey curriculum mes-sages to clients. Future additional re-sources may include the developmentof an exercise component, cookingdemonstrations, and additional clienthandouts.

NOTE

From the Pyramid to the Plate: HealthyEating by Timing, Combining, and Plan-ning is available on-line at http://virtual.clemson.edu/groups/eatwell/curricula.htm.

ACKNOWLEDGMENTS

Funded by the US Department ofAgriculture Food and Nutrition Ser-vices Food Stamp Nutrition Educa-tion Program.The authors would liketo thank Suzanne Medders and RobinStegall for their assistance in the devel-opment of the curriculum.

REFERENCES

1.American Diabetes Association.Diabetes A to Z: What You Need toKnow About Diabetes—Simply Put.4th ed. Alexandria, Va: AmericanDiabetes Association; 2000.

2.Warshaw HS. Diabetes Meal Plan-ning Made Easy: How to Put thePyramid to Work for Your BusyLifestyle. 2nd ed. Alexandria, Va:American Diabetes Association;2000.

157

GEM

GEM NO. 375

From the Pyramid to the Plate:A Curriculum for Individuals and Groups with Type 2 Diabetes

Funded by the US Department of AgricultureFood and Nutrition Services Food Stamp Nutri-tion Education Program.

158 Kunkel and Luccia/GEM NO. 375 ( J Nutr Educ Behav. 2004;36:157-158.)

Table. Results of a Multiple-Choice Pre- and Posttest Administered to Nutrition

Educators and Nutrition Educator Assistants as Part of a Training Session for the

Curriculum From the Pyramid to the Plate: Healthy Eating by Timing, Combining, and

Planning

Pretest Post-test Question Correct Answer (n = 75) (n = 74) Change

1. Diabetes is a condition Sugar 97% 99% +2% which results in higher than normal blood _____levels.

2. Potatoes, pasta, and Carbohydrates 95% 96% +1%cereal are in which food group?

3. It is important to control True 100% 99% �1%the portion size of each food when eating.

4. Dried beans, fish, and Proteins 89% 88% –1% turkey are in which food group?

5. It is important to never True 100% 100% 0skip meals and eat at regular times throughout the day.

6. I always prepare a meal True 53% 87% +34%*plan for the week.

7. I always use a shopping True 79% 88% +9%*list when going to the grocery store.

8. Skim milk and fat-free Protein and 65% 78% +13%*yogurt are in which food carbohydrategroups?

9. One half cup of corn One portion in the 45% 89% +44%*is _____. carbohydrate group

10. Honey is not considered False 81% 76% �5%*a sugar.

11. It is important to balance True 95% 96% +1%carbohydrate and protein every time I eat.

12. Which foods will cause All of the above 67% 76% +9%*an increase in blood (carbohydrate, sugar levels? protein, fat)

13. Which one is a balanced Cereal, milk, and 81% 74% �7%*breakfast? juice

14. Which one is a balanced Fruit and yogurt 65% 93% +28%*snack?

15. Which one is a balanced Hamburger, squash, 60% 73% +13%*lunch/dinner? salad with dressing,

and bread

*Levels of change significant at P < .05.