title: The role of diet behaviors in achieving improved glycemic control in intensively treated patients in the Diabetes Control and Complications Trial.
abstract: OBJECTIVE
  To determine whether specific diet-related behaviors practiced by IDDM patients in the intensive treatment group of the Diabetes Control and Complications Trial were associated with lower HbA1c values.
  
  
  METHODS
  A questionnaire addressing various aspects of their dietary behavior during the previous year in the DCCT was completed by 623 DCCT intensive treatment group subjects. The association between self-reported diet behaviors and the subject's mean HbA1c during the previous year was evaluated using a linear rank test for trend. The goal of intensive treatment was to achieve blood glucose and HbA1c levels as close to the nondiabetic range as possible without hypoglycemia.
  
  
  RESULTS
  Adherence to the prescribed meal plan and adjusting food and/or insulin in response to hyperglycemia were significantly associated with lower HbA1c levels. Over-treating hypoglycemia and consuming extra snacks beyond the meal plan were associated with higher HbA1c levels. Adjusting insulin dose for meal size and content and consistent consumption of an evening snack were associated, albeit to a lesser degree, with lower HbA1c.
  
  
  CONCLUSIONS
  The average HbA1c among intensively managed patients who reported that they followed specific diet-related behaviors was 0.25 to 1.0 lower than among subjects who did not follow these behaviors. Health-care providers may wish to use these results to focus clinical care for intensively treated IDDM patients by emphasizing counseling on meal plans, prompt response to high blood glucose levels, appropriate treatment of hypoglycemia, and consistent snacking behaviors.
authors.affiliation: Department of Dietetics, Massachusetts General Hospital, Boston 02114.
authors.forename: L M
authors.initials: LM
authors.lastname: Delahanty
authors.forename: B N
authors.initials: BN
authors.lastname: Halford
mesh_terms: D001519:Behavior / Q000502:physiology*; D001786:Blood Glucose / Q000032:analysis*; D003131:Combined Modality Therapy; D003422:Critical Care; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000178:diet therapy* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004435:Eating / Q000502:physiology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin