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: 8.57). 10/2009; 32(12):2174-6. DOI: 10.2337/dc09-1302
Source: PubMed

ABSTRACT 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.

Download full-text


Available from: Tonja Nansel, Jul 02, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to examine associations of food preferences and availability with dietary intake in youth with type 1 diabetes, for whom dietary intake and quality are essential to disease management. Youth (n=252, age 13.2±2.8 y, diabetes duration 6.3±3.4 y) reported preferences and parents reported household availability for 61 food items categorized as fruit, vegetables, whole grains, refined grains and fats/sweets. Youth energy-adjusted daily servings of food groups, Healthy Eating Index-2005 and Nutrient Rich Foods 9.3 scores were calculated from 3-day diet records. Associations of dietary intake and quality variables with preference and availability of all food groups were evaluated by linear regressions adjusted for sociodemographic characteristics. Fruit and whole grain intake were positively related to corresponding preference and availability; whole grain intake and refined grain availability were inversely related. Vegetable, refined grain and fats/sweets intake were unrelated to preference and availability. Diet quality measures were related positively to fruit preference and whole grain availability and inversely to refined grains availability. Findings indicate associations of dietary intake with food preference and availability vary by food group in youth with type 1 diabetes. Measures of overall dietary quality were more consistently associated with food group availability than preferences.
    Appetite 05/2012; 59(2):218-23. DOI:10.1016/j.appet.2012.05.005 · 2.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The current standard of care for patients with type 1 diabetes (T1D) employs a system of intensive diabetes management aimed at near-normal glycemia, which reduces the risk of micro- and macrovascular complications. Optimal management is an ongoing process based on a patient-centered collaboration with a primary care clinician and a multidisciplinary diabetes team that provides diabetes management, including education and psychosocial support. Intensive diabetes therapy attempts to mimic physiologic insulin replacement. Over the past 15 years, there has been widespread use of multiple-dose insulin regimens using a variety of insulin analogs, administered either by injection or insulin pump therapy, together with medical nutrition therapy, frequent self-monitoring of blood glucose and, more recently, continuous logo glucose monitoring. It is now possible to achieve previously unattainable levels of glycemic control with less risk of severe hypoglycemia, and yet only a minority of patients achieves target hemoglobin A1c values. This review discusses contemporary management of T1D with a focus on health outcomes.
    Endocrinology and metabolism clinics of North America 09/2010; 39(3):573-93. DOI:10.1016/j.ecl.2010.05.002 · 2.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE:To document body mass index and food intake in relation to level of carbohydrate counting in children with type 1 diabetes.METHODS:Weight, height, glycated hemoglobin and two 24-hour dietary recalls were recorded in 70 children with type 1 diabetes (age 6 to 12 years) on intensive insulin therapy, with a meal plan based on basic (n=21) or advanced (n=49) carbohydrate counting.RESULTS:The distribution of weight status (not overweight, overweight, obese) was similar in both meal plan groups, and the overall prevalence of overweight (15.7%) and obesity (5.7%) was similar to that of the general Quebec youth population. Mean intake of fibre and potassium was lower than adequate intake, regardless of sex and age. Vitamin C was the nutrient with the highest prevalence of inadequate intake. Children using advanced carbohydrate counting drank less milk (p<0.03) and tended to have lower vitamin D intake (p<0.06) than children using basic carbohydrate counting, but no other differences were detected in food, energy or nutrient intake. Added sugar represented < 10% of total energy intake in both the basic and advanced groups.CONCLUSION:Meal plans based on carbohydrate counting do not appear to expose school-aged children with type 1 diabetes to a greater risk of obesity or overweight. Contrary to what is sometimes assumed, advanced carbohydrate counting did not lead to higher energy or sugar intake in this sample. Although their diet is similar to that of children without diabetes, children with type 1 diabetes should receive education about adequate food choices to increase their intake of fibre and micronutrients.RÉSUMÉOBJECTIF :Établir le lien entre l'indice de masse corporelle et l'apport alimentaire, d'une part, et la méthode de calcul des glucides, d'autre part, chez des enfants atteints de diabète de type 1.MÉTHODES :On a mesuré le poids, la taille et l'hémoglobine glycosylée et demandé aux enfants ce qu'ils avaient mangé pendant deux périodes de 24 heures. L'étude a été menée auprès 70 enfants atteints de diabète de type 1 (de 6 à 12 ans) recevant une insulinothérapie intensive et dont le plan de repas était fondé sur un calcul des glucides de base (n = 21) ou avancé (n = 49).RÉSULTATS :La distribution de statut de poids (pas de surpoids, surpoids, obésité) était semblable dans les deux groupes de plan de repas et la prévalence globale du surpoids (15,7 %) et de l'obésité (5,7 %) était semblable à celle observée chez les jeunes dans la population générale du Québec. La consommation moyenne de fibre et de potas-sium était insuffisante, indépendamment de l'âge et du sexe. La vitamine C était le nutriment pour lequel l'apport était le plus souvent insuffisant. Les enfants qui utili-saient le calcul avancé des glucides buvaient moins de lait (p < 0,03) et avaient tendance à consommer moins de vita-mine D (p < 0,06) que les enfants qui utilisaient le calcul de base des glucides, mais aucune autre différence n'a été observée pour ce qui est de l'apport en aliments, en éner-gie et en nutriments. Le sucre ajouté constituait < 10 % de l'apport énergétique total tant dans le groupe utilisant la méthode de base que dans celui utilisant la méthode avancée.CONCLUSION:Les plans de repas fondés sur le calcul des glucides ne semblent pas augmenter le risque de surpoids ou d'obésité chez les enfants d'âge scolaire atteints de diabète de type 1. Contrairement à ce qu'on suppose parfois, le calcul avancé des glucides n'a pas entraîné d'augmentation de l'apport en énergie ni en sucre. Les enfants atteints de diabète de type 1 ont une alimentation semblable à celle des autres enfants, mais il faut leur apprendre à faire de bons choix alimentaires pour augmenter leur consommation de fibre et d'oligoéléments.
    Canadian Journal of Diabetes 01/2011; 35(3):254–261. DOI:10.1016/S1499-2671(11)53008-4 · 0.46 Impact Factor