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Greater diet quality is associated with more optimal glycemic control in a longitudinal study of youth with type 1 diabetes
Open accessAbstract
Background Despite the centrality of nutrition in the management of type 1 diabetes, the association of diet quality and macronutrient distribution with glycemic control is ambiguous.Objective This study examined longitudinally the association of dietary intake with multiple indicators of glycemic control in youth with type 1 diabetes participating in a behavioral nutrition intervention study.Design Participants in a randomized clinical trial of a behavioral nutrition intervention [n = 136; mean ± SD age: 12.8 ± 2.6 y; glycated hemoglobin (HbA1c): 8.1% ± 1.0%; 69.1% using an insulin pump] completed 3-d diet records at baseline and months 3, 6, 9, 12, and 18; masked continuous glucose monitoring (CGM) data were obtained concurrently with the use of the Medtronic iPro CGM system. HbA1c was obtained every 3 mo; 1,5-anhydroglucitol was obtained every 6 mo. Linear mixed-effects regression models estimated associations of time-varying dietary intake variables with time-varying glycemic control indicators, controlling for age, height, weight, sex, Tanner stage, diabetes duration, regimen, frequency of blood glucose monitoring, physical activity, and treatment assignment.Results HbA1c was associated inversely with carbohydrate and natural sugar, and positively with protein and unsaturated fat. 1,5-Anhydroglucitol was associated positively with fiber intake and natural sugar. Greater glycemic control as indicated by ≥1 CGM variable was associated with higher Healthy Eating Index-2005, whole plant food density, fiber, carbohydrate, and natural sugar and lower glycemic index and unsaturated fat.Conclusions 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.
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“The consumption of sugar-sweetened beverages and processed food products with large amounts of refined grains and added sugars is strongly discouraged (172,178,179), as these have the capacity to displace healthier, more nutrient-dense food choices.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [178]
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Metadata
- Authors
- Nansel, T. R., Lipsky, L. M., & Liu, A.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Nansel, Tonja R
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 104
- Issue
- 1
- Pages
- 81-87
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC4919526
- OpenAlex
- W2398039275
- Cited by
- 117
- References
- 36
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 12 · 2023: 14 · 2022: 17 · 2021: 22 · 2020: 7 · 2019: 7 · 2018: 14 · 2017: 4 · 2016: 1
- FWCI
- 8.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH
- National Institute of Child Health and Human Development (HHSN267200703434C, HHSN2752008000031/HHSN275002)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- type 1 diabetes, youth, diet quality, glycemic control, macronutrient distribution, HbA1c, 1,5-anhydroglucitol, continuous glucose monitoring, dietary fiber, glycemic index, unsaturated fat, natural sugars, carbohydrate intake, protein intake, Healthy Eating Index-2005
- MeSH terms
- Adolescent, Blood Glucose, Child, Deoxyglucose, Diabetes Mellitus, Type 1, Diet, Dietary Carbohydrates, Dietary Fats, Unsaturated, Dietary Fiber, Dietary Proteins, Female, Glycated Hemoglobin, Humans, Insulin, Longitudinal Studies, Male, Diet Records, Glycemic Index
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