Nutrition interventions for intensive therapy in the diabetes control and complications trial

Anderson, Ellen J.; Delahanty, Linda M.; Richardson, M. Antoinette; Cercone, Susan; Lyon, Rachel; Mueller, Dru; Snetselaar, L G

doi:10.1016/0002-8223(93)91750-k

Cited by 126 publications

(56 citation statements)

References 12 publications

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“…One possible contribution to the delayed divergence of the total CVD event curves in the INT group could have been the additional nutritional counseling provided by dietitians to DCCT participants who were gaining weight rapidly, a prevention strategy implemented when unwanted weight gain accompanying intensive management became apparent during pilot and feasibility testing before the start of the DCCT (14,15). Another potential explanation is that the group with excessive weight gain reported taking medications for blood pressure and to lower lipids at higher rates than the group with minimal gain during EDIC follow-up.…”

Section: Discussionmentioning

confidence: 99%

Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

et al. 2017

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OBJECTIVEIntensive treatment (INT) of type 1 diabetes reduces the incidence of cardiovascular disease (CVD) events compared with conventional treatment (CONV), but it also results in more weight gain. Our objective was to examine whether excessive weight gain from INT of type 1 diabetes is independently associated with subsequent CVD events.RESEARCH DESIGN AND METHODSQuartiles (Q) of weight gain in 1,213 participants aged 18 years and older at enrollment in the Diabetes Control and Complications Trial (DCCT) were determined within randomized treatment groups (INT vs. CONV) using change in BMI from baseline to the closeout DCCT visits. Effects of this weight gain on CVD risk factors and outcomes during an additional 20 years of observational follow-up were then determined.RESULTSThe Q4 INT group experienced greater proportional weight gain (median change in BMI, 6.08 kg/m2), increases in CVD risk factors, and need for medications for hypertension and lipids compared with the Q1–3 INT and comparable CONV groups. Over a mean of 26 years of follow-up, the numbers of major and total CVD events were not statistically different in Q4 compared with Q1–3 of either the INT or CONV group. By year 14, however, the incident CVD event curve became significantly higher in the Q4 INT group than in the Q1–3 INT groups (P = 0.024) and was similar to that for the CONV group.CONCLUSIONSFor the first 13 years after DCCT, INT for type 1 diabetes reduced macrovascular events compared with CONV, even when excessive weight gain occurred. After this, total CVD events significantly increased in the Q4 INT group, becoming equivalent to those in the CONV group. Longer follow-up is needed to determine whether this trend continues and results in more major CVD events.

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Section: Discussionmentioning

confidence: 99%

Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

et al. 2017

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“…Secondarily, the treatment is aimed at the prevention of the long-term chronic complications and early mortality [1–7, 12]. …”

Section: Discussionmentioning

confidence: 99%

“…The results from the DCCT have demonstrated the importance of medical diet therapy in the treatment of diabetes mellitus (DM). One of the diet strategies recommended by the DCCT is the carbohydrate counting method, which has started to draw attention in the recent years [1–7]. As the diabetes mellitus is a chronic disease which effects quality life and the mental status of patients, it is important to improve the quality life of such patients and to pay attention to the life style changes [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

Son

Efe

Son

et al. 2014

BioMed Research International

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Objective. The results from Diabetes Control and Complications Trial (DCCT) have propounded the importance of the approach of treatment by medical nutrition when treating diabetes mellitus (DM). During this study, we tried to inquire carbohydrate (Kh) count method's positive effects on the type 1 DM treatment's success as well as on the life quality of the patients. Methods. 22 of 37 type 1 DM patients who applied to Eskişehir Osmangazi University, Faculty of Medicine Hospital, Department of Endocrinology and Metabolism, had been treated by Kh count method and 15 of them are treated by multiple dosage intensive insulin treatment with applying standard diabetic diet as a control group and both of groups were under close follow-up for 6 months. Required approval was taken from the Ethical Committee of Eskişehir Osmangazi University, Medical Faculty, as well as informed consent from the patients. The body weight of patients who are treated by carbohydrate count method and multiple dosage intensive insulin treatment during the study beginning and after 6-month term, body mass index, and body compositions are analyzed. A short life quality and medical research survey applied. At statistical analysis, t-test, chi-squared test, and Mann-Whitney U test were used. Results. There had been no significant change determined at glycemic control indicators between the Kh counting group and the standard diabetic diet and multiple dosage insulin treatment group in our study. Conclusion. As a result, Kh counting method which offers a flexible nutrition plan to diabetic individuals is a functional method.

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“…This often involves 2 to 4 hours with the dietician and follow-up visits with the dietician over 3 to 12 months, often more frequently at the beginning of intensive management. The grams of carbohydrate, carbohydrate exchanges, or total available glucose (TAG; 58% of protein and 10% of fat are calculated into the grams of carbohydrate) can be used to estimate food impact on glucose levels and insulin needs [25]. Although food intake can be adjusted to meet the demands of injected insulin, many patients prefer to adjust insulin doses to their food intake.…”

Section: Dietmentioning

confidence: 99%

Intensive diabetes management in pediatric patients

2001

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Intensive diabetes management requires frequent home glucose monitoring, multiple daily insulin injections or chronic subcutaneous insulin infusion, and adjustments of insulin doses in response to changes in blood glucose levels, food intake, and exercise. It also requires a periodic review of previous glucose results to recognize patterns of hyper- or hypoglycemia. The goals of intensive management are age dependent. In young children, avoidance of severe hypoglycemia is the major goal. In older children and adolescents, lowering hemoglobin A(1c) becomes an increasingly important goal. In children of all ages, the ability to have a flexible lifestyle and meal plan is often a priority. This article provides a brief overview of the rationale for implementing intensive diabetes management in pediatric patients, and practical guidelines for implementation.

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Nutrition interventions for intensive therapy in the diabetes control and complications trial

Cited by 126 publications

References 12 publications

Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

Investigation on Carbohydrate Counting Method in Type 1 Diabetic Patients

Intensive diabetes management in pediatric patients

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