There are currently too few studies of sufficient quality to determine the benefits of using stagebased dietary counseling, as opposed to traditionalcounseling, in primary care settings, among individuals with diabetes or with an elevated risk of diabetes. Because the effectiveness of TTM-based counseling is strongly dependent on the effectiveness of the education and training given to providers,such studies should be treated as studies with two separate educational interventions, each with its own evaluation. Thus, we would support a previous conclusion [41], i.e. that a modified critical appraisal tool should be created for evaluating studies with two separate educational interventions. n order to assess whether the providers have truly changed their counseling behavior, a multilevel assessment of behavior change outcomes should be included as part of an evaluation of the outcomes of providers’ training. In addition, a careful process evaluation of the counseling sessions is required.