I echo all of the concerns voiced above and by far it seems that a lack of motivation, the inability to maintain the healthy eating behavior long term is a challenge. This applies to self management of most chronic conditions. As an RD CDE and health coach, I try to use more action based strategies, involve pt. more in their own decisions, empower them with easy to sue tools and encourage routine follow ups with their diabetes care team. People tend to slack off on their follow ups once the A1c is on target.