To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support (DSME/S).

We randomized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education. The primary outcome was change in HbA_1C over 6 months.

At 6 months, HbA_1C improved within the plate method [−0.83% (−1.29, −0.33), P < 0.001] and carbohydrate counting [−0.63% (−1.03, −0.18), P = 0.04] groups but not the control group [P = 0.34]. Change in HbA_1C from baseline between the control and intervention groups was not significant at 6 months (carbohydrate counting, P = 0.36; modified plate method, P = 0.08). In a pre-specified subgroup analysis of patients with a baseline HbA_1C 7–10%, change in HbA_1C from baseline improved in the carbohydrate counting [−0.86% (−1.47, −0.26), P = 0.006] and plate method groups [−0.76% (−1.33, −0.19), P = 0.01] compared to controls.

CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA_1C between 7 and 10%.

Both carbohydrate counting and the modified plate method improve glycemic control as part of DSME/S.