title: Liberalized diet in patients with type 1 diabetes.
abstract: OBJECTIVE
  To document that strict dietary regimen are not necessary in the context of intensified insulin therapy.
  
  
  METHODS
  German multicentre, prospective cohort study; 6 years follow-up.
  
  
  METHODS
  Ambulatory examination using a mobile ambulance.
  
  
  METHODS
  A total of 636 type 1 diabetic patients (age 33 +/- 7 years, diabetes duration 15 +/- 7 years; mean +/- SD), who had participated in a structured, 5-day, in-patient, group treatment and teaching programme for intensification of insulin therapy and liberalization of the diabetes diet 6 years prior to follow-up.
  
  
  METHODS
  Relations between the extent to which patients practise a liberalized diet, the degree of metabolic control (HbA1c, severe hypoglycaemia, body mass index, cholesterol), and the patients' perceived burden through dietary treatment.
  
  
  RESULTS
  In the total patient group, HbA1c was 7.9 +/- 1.6%, and the incidence of severe hypoglycaemia was 0.17 cases per patient during the preceding year; 31% patients injected insulin < or = 3 times per day, 58% 4-7 times per day, and 11% used insulin pump therapy. Only 11% patients reported following a meal plan, whereas 89% continually changed timing and amount of carbohydrate intake; only 5% had the same number of meals every day, whereas as many as 20% varied the number of meals per day by four or more; 53% skipped main meals; 85% habitually consumed sugar or sugar containing foods. Patients with a higher degree of diet liberalization injected insulin or used an insulin pump therapy more frequently, and perceived their dietary treatment to be less burdensome. No clinically significant associations were found between the extent of diet liberalization and metabolic control.
  
  
  CONCLUSIONS
  Under the conditions where type 1 diabetic patients have the opportunity to participate in an intensified insulin treatment and teaching programme, liberalization of the diabetes diet is not associated with adverse effects on glycaemic control, but is associated with less perceived burden through dietary treatment.
authors.affiliation: Department of Nutrition and Metabolic Diseases (WHO-Collaborating Centre for Diabetes), Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Mühlhauser
authors.forename: U
authors.initials: U
authors.lastname: Bott
authors.forename: H
authors.initials: H
authors.lastname: Overmann
authors.forename: W
authors.initials: W
authors.lastname: Wagener
authors.forename: R
authors.initials: R
authors.lastname: Bender
authors.forename: V
authors.initials: V
authors.lastname: Jörgens
authors.forename: M
authors.initials: M
authors.lastname: Berger
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin