Associations of nutrient intake with glycemic control in youth with type 1 diabetes: differences by insulin regimen.
BACKGROUND
Type 1 diabetes management has evolved from meal plans towards flexible eating with carbohydrate counting. With this shift, youth with type 1 diabetes may consume excess fat and insufficient fiber, which may impact glycemic control. Few studies consider whether insulin regimen influences associations between dietary intake and hemoglobin A1c.


METHODS
In this cross-sectional study, 252 youth (52% male; age, 13.2 ± 2.8 years; body mass index z-score [z-BMI], 0.7 ± 0.8) with type 1 diabetes completed 3-day food records. Dietary intake was compared with published guidelines. Logistic regression predicted the odds of suboptimal glycemic control (an A1c level of ≥ 8.5%) related to fat and protein intake or fiber intake according to insulin regimen (pump vs. injection) adjusting for age, sex, diabetes duration, z-BMI, insulin dose, glucose monitoring frequency, and total energy intake (TEI).


RESULTS
Youth had a mean TEI of 40.9 ± 15.4 kcal/kg/day and excess fat and insufficient fiber intake compared against published guidelines. Pump-treated youth consuming the highest quartile of fat intake (as percentage TEI) had 3.6 (95% confidence interval, 1.3-9.7) times the odds of a suboptimal A1c than those in the lowest quartile. No such association was found in injection-treated youth. In the total sample, youth with the lowest quartile of fiber intake had 3.6 (95% confidence interval, 1.4-9.0) times the odds of a suboptimal A1c, but this association did not differ by insulin regimen. There was no association between protein intake and A1c.


CONCLUSIONS
Higher fat intake in pump-treated youth and lower fiber intake in all youth were associated with an A1c level of ≥ 8.5%. Improving dietary quality may help improve A1c.
1 Pediatric, Adolescent and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center , Boston, Massachusetts.
Michelle L
ML
Katz
Sanjeev
S
Mehta
Tonja
T
Nansel
Heidi
H
Quinn
Leah M
LM
Lipsky
Lori M B
LM
Laffel
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001294:Attitude to Health; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000523:psychology; D004032:Diet / Q000009:adverse effects* / Q000523:psychology; D015930:Diet Records; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human