Aims To describe the contribution of diabetes nutrition therapy to disease self-management among individuals with Type 1 diabetes mellitus in China and to estimate the association of diabetes nutrition therapy with dietary intake. Methods The 3C Study was an epidemiological study of the coverage, cost and care of Type 1 diabetes in China. The data reported in the present study are from the 3C Nutrition Ancillary Study, a follow-up study conducted 1.6±0.2 years later. Diabetes nutrition therapy was assessed by an interviewer-administered questionnaire. Dietary intake was assessed using three 24-h recalls. The association of diabetes nutrition therapy with dietary intake was estimated using ANCOVA. Results Participants (n=100; 54% male) had a mean ± SD age of 41.7±16.3 years old and a mean ± SD diabetes duration of 11.8±9.7 years. Fewer than half of the participants reported that they had ‘ever’ met with a dietician. While 64% of participants were taught carbohydrate counting, only 12% ‘ever’ use this tool. Participants on insulin pumps and those testing ≥1 time/day reported greater dietary flexibility and higher fruit intakes compared with participants on other insulin regimens and testing less frequently. After adjustment for confounding by age and occupation, there were no consistent differences in dietary intake across subgroups of diabetes nutrition therapy. Conclusions In this sample of individuals with Type 1 diabetes in China there is little dietician involvement or carbohydrate counting. Increased frequency of nutrition education in conjunction with intensified self-monitoring of blood glucose is needed to improve care.
Background Coronary artery calcification (CAC) is a crucial indicator of subclinical atherosclerotic cardiovascular disease. The relationship between long‐term insulin resistance (IR) trajectory and CAC has been explored in few studies. Therefore, this study aimed to investigate whether the long‐term IR time series of young adults are associated with the incidence of CAC in midlife. Methods and Results In a cohort study comprising 2777 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study, the homeostasis model assessment for IR was used to measure IR levels, and group‐based trajectory modeling was used to fit three 25‐year homeostasis model assessments for IR trajectories. Logistic regression was used to estimate the association between the 3 homeostasis model assessments for IR trajectories and CAC events at year 25. The results showed that among 2777 participants (mean age, 50.10±3.58 years; 56.2% women; 46.4% Black), there were 780 incident CAC events after a 25‐year follow‐up. After full adjustment, the prevalence of CAC was higher in the moderate‐ (odds ratio [OR], 1.40 [1.10–1.76]) and the high‐level homeostasis model assessments for IR trajectories (OR, 1.84 [1.21–2.78]) than in the low‐level trajectory. This association was observed in obese individuals despite the negative interaction between IR and different types of obesity (all P interactions >0.05). Conclusions Our study revealed that young adults with a higher level of IR were more likely to develop CAC in middle age. Furthermore, this association persisted in obese individuals. These findings highlight the importance of identifying subclinical cardiovascular risk factors and implementing primary prevention measures.
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