Improving dietary quality in youth with type 1 diabetes: randomized clinical trial of a family-based behavioral intervention

Abstract

BackgroundDiets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in foods of minimal nutritional value, increasing risk for future adverse health outcomes. This 18-month randomized clinical trial tested the effect of a family-based behavioral intervention integrating motivational interviewing, active learning, and applied problem-solving on the primary outcomes of dietary intake and glycemic control among youth with type 1 diabetes.MethodsA parallel-group study with equal randomization was conducted at an outpatient, free-standing, multidisciplinary tertiary diabetes center in the United States. Eligible youth were those age 8–16 years with type 1 diabetes diagnosis ≥1 year and hemoglobin A1c (HbA1c) ≥6.5% and ≤10.0%. Participants were 136 parent-youth dyads (treatment n = 66, control n = 70). The intervention consisted of 9 in-clinic sessions delivered to the child and parent; control condition comprised equivalent assessments and number of contacts without dietary advice. Dietary intake was assessed using 3-day diet records at 6 time points across the 18-month study. Dietary outcomes included the Healthy Eating Index-2005 (HEI2005; index measuring conformance to the 2005 United States Dietary Guidelines for Americans) and Whole Plant Food Density (WPFD; number of cup or ounce equivalents per 1000 kcal of whole grains, whole fruit, vegetables, legumes, nuts, and seeds consumed). HbA1c was obtained every 3 months. Overall comparison of outcome variables between intervention and usual care groups was conducted using permutation tests.ResultsThere was a positive intervention effect across the study duration for HEI2005 (p = .015) and WPFD (p = .004). At 18 months, HEI2005 was 7.2 greater (mean ± SE 64.6 ± 2.0 versus 57.4 ± 1.6), and WPFD was 0.5 greater (2.2 ± 0.1 versus 1.7 ± 0.1) in the intervention group versus control. There was no difference between groups in HbA1c across the study duration.ConclusionsThis behavioral nutrition intervention improved dietary quality among youth with type 1 diabetes, but did not impact glycemic control. Findings indicate the potential utility of incorporating such strategies into clinical care, and suggest that improvement in diet quality can be achieved in families living with this burdensome disease.Trial registrationClinicaltrials.gov registration number: NCT00999375Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-015-0214-4) contains supplementary material, which is available to authorized users.

Glycemic control and variability in association with body mass index and body composition over 18months in youth with type 1 diabetes

“…Details regarding recruitment and randomization are described in detail elsewhere [23]. Eligibility criteria included age 8.0–16.9 years, diagnosis of type 1 diabetes ⩾1 year, daily insulin dose ⩾0.5 units per kilogram, most recent HbA1c ⩾6.5% (48 mmol/mol) and ⩽10.0% (86 mmol/mol), with either an insulin regimen of ⩾3 injections daily or insulin pump, at least one clinic visit in the past year, and ability to communicate in English.…”

“…Participants in the control condition received equal frequency of contacts with research staff. Further details regarding the intervention and control conditions have been previously reported [23]. At enrollment, all youth provided assent, and parents provided written informed consent; youth turning 18 years of age during the trial additionally provided written informed consent.…”

I Should but I Can't: Controlled Motivation and Self-Efficacy Are Related to Disordered Eating Behaviors in Adolescents With Type 1 Diabetes

“…As detailed elsewhere (26), eligibility criteria for the main trial included: age 8.0–16.9 years, diagnosis of type 1 diabetes ≥ 1 year, daily insulin dose ≥ 0.5 units per kilogram, most recent hemoglobin A1c ≥ 6.5% and ≤ 10.0%, insulin regimen of ≥ 3 injections daily or use of insulin pump, at least one clinic visit in the past year, and ability to communicate in English. Criteria were chosen to ensure that participants had no residual insulin production and to exclude participants with very poor glycemic control, who are unlikely to be ready for the additional effort required to change dietary intake.…”

“…The intervention included nine sessions employing behavioral techniques and educational content to promote increased intake of whole plant foods (i.e., fruit, vegetables, whole grains, legumes, nuts, and seeds) (26). The intervention did not target weight loss or disordered eating.…”

Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth With Type 1 Diabetes: Lifestyle and Beyond

“…Nutrition education is recognized as necessary, but insufficient as the sole strategy to address all of the factors that impact dietary behaviors. Behavioral approaches that increase motivation and promote skill development for children and families may increase the likelihood of achieving dietary behavior change [59]. Further studies on behavioral nutrition interventions in T1D youth are needed.…”