Emphasis on Carbohydrates May Negatively Influence Dietary Patterns in Youth With Type 1 Diabetes

Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts, USA.
Diabetes care (Impact Factor: 8.42). 10/2009; 32(12):2174-6. DOI: 10.2337/dc09-1302
Source: PubMed


To assess perceptions of healthful eating and the influence of diabetes management on dietary behaviors among youth with type 1 diabetes and parents.
Youth with type 1 diabetes (n = 35), ages 8-21 years, and parents participated in focus groups. Focus group recordings were transcribed and coded into themes. Clinical data were abstracted from the electronic medical record.
Central topics were perceptions of healthful eating and the impact of diabetes management on diet. An emphasis on limiting postprandial glycemic excursions occasionally contradicted the traditional perception of healthful eating, which emphasized consumption of nutrient-dense whole foods in favor of prepackaged choices. Whereas fixed regimens required more rigid diets, basal-bolus regimens provided more opportunities for unhealthful eating. Most youth perceived "refined" grains as more healthful grains.
For youth with type 1 diabetes and parents, an emphasis on carbohydrate quantity over quality may distort beliefs and behaviors regarding healthful eating.

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    • "Some participants reported that their fat consumption increased as carbohydrate free, high fat meals were perceived as the easy option (Lawton et al., 2011). Given that people with type 1 diabetes reportedly have higher total fat and saturated fat intakes than healthy people (Overby et al., 2006; Helgeson, Viccaro, Becker, Escobar, & Siminerio, 2006) and their fruit, vegetable and fiber intakes fall below recommendations (Pietilainen, Virtanen, Rissanen, Rita, & Maenpaa, 1995; Nansel et al., 2012), care is needed when teaching carbohydrate counting that an emphasis on carbohydrate does not detract from healthy eating principles (Mehta, Haynie, et al., 2009). Interventions to improve accuracy may need to focus on novel methods including displays of real foods to assist young people to accurately estimate carbohydrate. "
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    • "Both adolescents and adults generally understand fundamental principles of healthful eating, including which foods are more and less healthful [49,50]. Additionally, findings from focus groups among youth with type 1 diabetes [51,52] indicate that while youth widely perceive fruit and vegetable intake as relevant to healthful eating, they also understand the concept of healthful eating to encompass dietary behaviors such as fiber and whole grain intake, as well as limiting intake of nutrient-poor foods (e.g., snack foods, sweets). Such findings suggest the potential utility of examining social cognitive constructs as they relate to overall diet quality. "
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    • "** p < 0.01. ulation, despite differential dietary considerations for diabetes management, such as ease of carbohydrate estimation or preference for foods requiring no insulin administration (Mehta, Haynie, et al., 2009). For the most part, food group preference and availability in this sample were unrelated to intake of non-corresponding food groups. "
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