Day-to-day consistency in amount and source of carbohydrate intake associated with improved blood glucose control in type 1 diabetes.
OBJECTIVE
To determine if a relationship exists between blood glucose control and variability in nutrient intake from day-to-day in subjects with type 1 diabetes.


METHODS
Two three-day diet records and one measurement of glycated hemoglobin (HbA1c) were obtained from 272 subjects with type 1 diabetes treated with a mixture of regular and NPH insulins before breakfast and supper and using a standardized algorithm to adjust insulin dose according to the results of self-monitoring of blood glucose two to four times daily. Day-to-day variation in nutrient intake was expressed as the coefficient of variation (CV = SDx100/mean).


RESULTS
Nutrient intakes in the study population (mean +/- SD) were energy 8.35+/-2.43 MJ, fat 81+/-30 g, protein 94+/-28 g, carbohydrate 227+/-68 g, starch 126+/-38 g and dietary fiber 20+/-6 g with diet glycemic index being 84.2+/-7.4. Neither energy, nutrient intakes nor insulin dose was significantly related to HbA1c. Day-to-day variation of carbohydrate (p = 0.0097) and starch (p = 0.0016) intakes and diet glycemic index (p = 0.033) was positively related to HbA1c, and the associations remained significant when adjusted for age, sex, duration of diabetes and BMI. Day-to-day variation in energy, protein or fat intakes was not related to HbA1c.


CONCLUSIONS
Consistency in the amount and source of carbohydrate intake from day-to-day is associated with improved blood glucose control in people with type 1 diabetes, a result which supports continued educational efforts to achieve adherence to a diabetes diet plan. This conclusion may not apply to people on intensified insulin therapy who adjust their insulin dose based on their actual carbohydrate intake at each meal.
Wolever
T M
TM
Department of Nutritional Sciences, University of Toronto, St. Michael's Hospital, Ontario, Canada.
Hamad
S
S
Chiasson
J L
JL
Josse
R G
RG
Leiter
L A
LA
Rodger
N W
NW
Ross
S A
SA
Ryan
E A
EA
D000293:Adolescent; D000328:Adult; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy; D015930:Diet Records; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009753:Nutritive Value
D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007328:Insulin