Dietary adherence and associated glycemic control in families of young children with type 1 diabetes.

Department of Pediatrics and Communicable Diseases, CS Mott Childrnen's Hospital, University of Michigan, Ann Arbor, MI 48109, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 02/2007; 107(1):46-52. DOI: 10.1016/j.jada.2006.10.012
Source: PubMed

ABSTRACT This study examined the dietary intake, dietary adherence, and associated daily glycemic control of young children (mean age 5.6+/-1.6 years) with type 1 diabetes in 33 families.
This was a one-sample cross-sectional study. Children's nutrient and energy intakes were measured using 3-day diet diaries. Children's mean daily blood glucose levels were assessed prospectively for 2 weeks using the FreeStyle (TheraSense, Inc, Alameda, CA) home blood glucose meter.
Means, standard deviations, and frequencies described the sample. Associations between dietary adherence and glycemic control were examined by one-tailed Pearson correlations.
Mean nutrient intakes were less than the Dietary Reference Intake for children's intake of vitamin B-12 and calcium. Children's dietary deviations revealed better-than-predicted adherence to the number and timing of feedings per day and number of carbohydrate units consumed per meal. In contrast, children's daily carbohydrate intake was approximately 80%+/-21% of the recommended levels based on their weight and age. In addition, children's energy intake was only 78%+/-18% of the recommended levels based on age. Correlations revealed a positive association between poor dietary adherence and higher blood glucose levels.
Young children with type 1 diabetes are likely to have adequate dietary intake of most micronutrients. However, their adherence to specific carbohydrate and energy intake recommendations may be lower. Because the preschool years represent a period of rapid growth, diet plans for preschoolers with diabetes need to be revised often for optimal management of type 1 diabetes. Close adherence to dietary recommendations is one behavior that may improve blood glucose control in young children with diabetes.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 +/- 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 +/- 8.1 years. Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies', (OR 1.57 [1.02-2.41]) were related to greater patients' adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients' adherence (p < 0.01). Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.
    Nutrition Journal 03/2014; 13(1):19. · 2.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Carbohydrate counting is used to adjust premeal insulin to carbohydrate intake in intensive insulin regimens. The aim of the present study was to determine the potential variability in the carbohydrate content of a slice of bread (one ‘exchange’) from that reported on the label and hence, the potential variability in carbohydrate intake when consuming a serve.Methods: A cross‐sectional survey of 11 different loaves of bread commonly consumed by children with type 1 diabetes was undertaken. All slices in each loaf were weighed to an accuracy of ±1 g; and the reported carbohydrate content per 100 g of each loaf was used to determine the carbohydrate content of the mean, minimum and maximum slice in each loaf of bread.Results: There was no difference between the reported and the mean estimated carbohydrate content of a slice. The minimum slice of bread across all loaves was estimated to contain only 10.0 g of carbohydrate, whereas the maximum slice contained an estimated 20.7 g of carbohydrate. The greatest variation in carbohydrate amount within a loaf was 12.3 g.Conclusions: In commercially available loaves of bread in Australia, the carbohydrate content of a slice can vary by up to 45% of that reported on the label, in accordance with Food Standards Australia New Zealand. This highlights a practical limitation inherent with the commonly held view that food labels can facilitate accuracy in carbohydrate counting in 1‐g increments.
    Nutrition &amp Dietetics 09/2011; 68(3). · 0.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To present results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (mean age, 5.0 ± 1.2 years) with type 1 diabetes mellitus (T1DM). The researchers recruited 9 caregivers who participated in the 6-session intervention and completed baseline and posttreatment assessments, which included dietary intake, acceptability of diet changes, mealtime behavior, and mean blood glucose values. Children's mean daily blood glucose levels decreased from 185 ± 46 mg/dL to 159 ± 40 mg/dL (P < .001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children's dietary intake indicators that could be detected. It appears promising that this targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with type 1 diabetes mellitus. Larger, randomized controlled trials will clarify significant results, limitations, and sustainability. Techniques within the program may have application to current practice.
    Journal of nutrition education and behavior. 01/2014;