###### Abstract  
This publication presents the development of a new mixed reality (MR) application for headsets, using grayscale and color passthrough to support therapeutic education in diabetes. Passthrough technology allows users to see their real-world environment through cameras on the headset. A comparative study was conducted to assess the effectiveness of our application in its two visualization modes against traditional learning and an augmented reality (AR) application. The study assessed the increase in patients' knowledge of the carbohydrate content of different foods, as well as the usability of and satisfaction with each application, with 92 Ecuadorian patients with Type 1 diabetes participating. The results indicate that all four learning methods positively influenced patient increase in knowledge (post-pre). However, pairwise comparisons of post-knowledge scores showed that the MR color passthrough and AR applications significantly outperformed the traditional method, with patients using color passthrough achieving greater post-learning outcomes than those using grayscale or AR. Positive post-knowledge outcomes were observed across all age and gender groups. The patient feedback on their experience with the MR application using color passthrough was significantly higher than with the grayscale version. Therefore, while all methods demonstrated positive effects on knowledge gain, the findings presented in this publication suggest that color passthrough offers great potential for creating engaging, context-rich, and interactive learning environments that have a positive effect on both learning and user experience. mixed reality; passthrough; therapeutic education; diabetes; nutritional education; carbohydrate management; healthcare; learning outcomes; user experience; Meta Quest 2025  
pancreas either fails to produce enough insulin or the body becomes resistant to its action. Although it is mostly seen in adults, its occurrence is rising among younger populations. Management often includes dietary adjustments, physical activity, and oral medications, with insulin therapy needed in advanced cases. Gestational diabetes mellitus arises during pregnancy when the body cannot produce or use sufficient insulin to meet the heightened demand [1]. Global data on diabetes shows a concerning rise in prevalence. According to the International Diabetes Federation ([[https://idf.org](https://idf.org)]([https://idf.org](https://idf.org)) (accessed on 18 February 2025)), around 537 million adults aged 20 to 79 were affected by diabetes in 2021. It is anticipated that this figure will grow significantly, with 643 million people projected to have diabetes by 2030, and 783 million by 2045. The rise is particularly pronounced in low- and middle-income countries, where three out of four adults live with diabetes. These statistics underscore the increasing global burden of diabetes, driven by factors such as urbanization, aging populations, and rising obesity levels. According to the World Health Organization ([[https://www.who.int](https://www.who.int)]([https://www.who.int](https://www.who.int)) (accessed on 18 February 2025)), diabetes is a major contributor to serious health complications, including strokes, blindness, kidney failure, heart attacks, and lower limb amputations. Therapeutic education in diabetes (TED) is a structured educational process that helps individuals with diabetes understand their condition, manage it effectively, and adopt essential self-care practices into their daily routines. TED covers key areas such as understanding diabetes, monitoring blood glucose, administering insulin, planning nutrition and diet, engaging in physical activity, preventing complications, accessing psychosocial support, and building self-management skills. This educational approach aims to empower patients to take an active role in managing their diabetes [2].