Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth‐onset type 1 and type 2 diabetes: TheSEARCHfor diabetes in youth study

Abstract

Aims: Examine associations of dietary strategies used to manage diabetes over time with hemoglobin A1c in youth-onset type 1 or type 2 diabetes. Methods: The SEARCH for Diabetes in Youth observational study assessed dietary strategies used by 1814 participants with diabetes (n = 1558 type 1, n = 256 type 2) at two to three research visits over 5.5 years (range 1.7-12.2). Participants reported often, sometimes, or never using 10 different dietary strategies, and use over time was categorized into five mutually exclusive groups: often using across visits; started using at later visits; sometimes using across visits; stopped using at later visits; or never using across visits. General multivariable linear models evaluated most recent A1c by use category for each strategy. Results: In type 1 diabetes, A1c was lower among those who starting tracking calories (−0.4%, Tukey P < .05), often counted carbs (−0.8%, Tukey P < .001), or sometimes chose low glycemic index foods (−0.5%, Tukey P = .02) vs those with less use, while participants who never drank more milk had the lowest A1c (−0.5%, Tukey P = .04). In type 2 diabetes, A1c was lower among those who often limited high fat

Association of Insulin Regimen and Estimated Body Fat Over Time among Youths and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

“…There is anecdotal evidence that the use of an insulin pump is associated with stronger attention and adherence to self-management than the use of injections. However, it is also plausible that an injection regimen may be associated with more planning and consistency regarding timing and content of food intake (and less "grazing") as opposed to perhaps greater flexibility of and variability in insulin and food patterns that may be more readily adopted on a pump regimen [36][37][38] and contribute to excess energy intake [39,40]. Future studies that include more direct measures of diabetes selfmanagement adherence will clarify the relationship between insulin regimen, adiposity, and specific characteristics of diabetes self-management behaviors that might shape the associations observed in the present analysis, including different eating patterns.…”

Twenty years of pediatric diabetes surveillance: what do we know and why it matters

“…Glycemic control and cardiovascular risk factors (obesity, dyslipidemia, and hypertension) were improved with greater adherence to the Dietary Approaches to Stop Hypertension (DASH) diet; [42][43][44] greater intake of leucine, protein, and fatty acid intake; 45 and a lower intake of fructose, 46 trans-fatty acids, 47 diet beverages, 48,49 sweetened beverages, eggs, potatoes, and high-fat meat. 50 Positive nutrition behaviors, such as counting carbohydrates 51,52 and eating <5 times/day, 53 were associated with better glycemic control for both types of pediatric diabetes. All of these analyses were adjusted for insulin regimen and other key clinical and sociodemographic covariates, highlighting a potential benefit of dietary intake on HbA1c and cardiovascular risks above and beyond clinical treatment.…”

Diabetic kidney disease in children and adolescents: an update

“…Current standards of care include dietary education, e.g., carbohydrate counting, calorie tracking and consumption of low glycemic index foods [ 25 ], and promotion of increased physical activity, all of which are associated with improved glycemic control [ 64 ]. However, these strategies continue to have limited success.…”

“…However, these strategies continue to have limited success. For example, only 20% and 30% of adolescents with T2D limit high-fat foods and use carbohydrate counting, respectively [ 64 ]. Dietary recommendations in youth must also consider the high prevalence of disordered eating behavior in youth with diabetes [ 65 ], itself associated with worse glycemic control and greater adverse outcomes.…”