Greater diet quality is associated with more optimal glycemic control in a longitudinal study of youth with type 1 diabetes

Abstract

Both overall diet quality and macronutrient distribution were associated with more optimal glycemic control. Associations were more consistent for CGM variables obtained concurrently with dietary intake than for biomarkers of longer-term glycemic control. These findings suggest that glycemic control may be improved by increasing intake of high-fiber, low glycemic-index, carbohydrate-containing foods. This trial was registered at clinicaltrials.gov as NCT00999375.

Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

“…Several factors, which are common in adolescents with or without T1D, such as sedentary behavior, reduced exercise (especially in females), and unhealthy eating habits, may contribute to favor a positive energy balance . Other factors favoring body fat accumulation are specific to diabetes, including extra calorie intake to prevent or correct hypoglycemia, the consumption of low carbohydrate high fat foods, to reduce postprandial glucose increase, and the chronic exposure of the peripheral tissues to non‐physiologic hyperinsulinemia due to the subcutaneous insulin injections or infusion via insulin pump . Nutritional strategies to reduce nocturnal hypoglycemia, if insulin pump or long‐acting analog insulin (such as glargine or degludec insulin) are not used, include the ingestion of a bedtime snack containing carbohydrates and protein, although the American Diabetes Association (ADA) and the Endocrine Society reported the absence of consensus on this practice .…”

“…Similar mechanisms may contribute to the frequently observed body weight gain in insulin‐treated patients. Due to the strong relationship between carbohydrate intake and postprandial glucose profile, modification of diet composition, with a reduction of carbohydrate, could be a potential strategy for limiting postprandial glucose excursions and fluctuations at least in the short term, although appropriate carbohydrate and fat intake was associated with lower HbA1c . Moreover, a low carbohydrate intake is associated with less favorable dietary nutrient composition, leading to overconsumption of protein and fat .…”

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

“…Early preprandial insulin administration up to 15 to 20 minutes before the meal or the addition of a moderate amount of protein to a meal containing predominantly carbohydrate can assist in reducing postprandial excursions. Substituting low‐Glycemic Index (GI) for High‐GI carbohydrate and increasing dietary fiber intake are other useful dietary options. A meal‐time routine with limits on snacking episodes can assist in preventing prolonged periods of postprandial hyperglycemia …”

“…Dietary fiber is associated with digestive health and modulates bowel function, fermentation and effects of gut microbiota Increasing fiber intake can assist in improving glycemic control Dietary fiber aids in laxation and should be increased slowly in the diet to prevent abdominal discomfort and should be accompanied by an increase in fluid intake. Diet high in whole grains may help to improve satiety, replace more energy dense foods and prevent weight gain Processed foods tend to be lower in fiber therefore; unprocessed, fresh whole foods should be encouraged. …”

Response to Letter to the Editor

“…Importantly, HEI is not a clinical indicator, but rather a measurement of compliance with the US Dietary Guidelines. There are no established thresholds to describe HEI values, and the score is instead analyzed as a continuous variable (see Nansel, Lipsky, and Liu, 2016 1 ) or categorized into ranks of sample distribution (see Reedy et al, 2014 2 ). However, applying the potential change noted above of a single standard deviation increase in NLit-P to the mean child HEI in our population (52.5) would theoretically increase HEI to 58.7, which corresponds to an increase from approximately the 50 th %ile to approximately the 75 th %ile of HEI reported in Guenther’s HEI-2010 validation study using the 2003–2004 NHANES dietary data 3 .…”