Enhancing Carbohydrate Quality in Diabetes Management

提高糖尿病管理中的碳水化合物质量

• 批准号: 8553930
• 负责人: Tonja Nansel
• 金额: $ 45.67万
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8553930
• 关键词: Accounting; Address; Adolescent; Age; American; Area; Behavior; Behavior Therapy; Behavioral; Belief; Blood Glucose; Blood Glucose Self-Monitoring; Body Composition; Camping; Carbohydrates; Cardiovascular Diseases; Caring; Child; Clinic; Cognitive; Complications of Diabetes Mellitus; Consumption; Crossover Design; Data; Development; Diabetes Mellitus; Diet; Dietary Carbohydrates; Dietary Fiber; Dietary Intervention; Dietary intake; Disease; Dose; Dyslipidemias; Eating; Eating Behavior; Education; Educational Technics; Exposure to; Fabaceae; Family; Focus Groups; Food; Food Patterns; Food Preferences; Frequencies; Glycemic Index; Glycosylated hemoglobin A; Goals; Guidelines; Health; High Prevalence; Home environment; Hyperglycemia; Hypoglycemia; Individual; Inflammation; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Life; Life Style; Link; Lipids; Maintenance; Masks; Measures; Mediator of activation protein; Metabolic; Modeling; Nutrient; Observational Study; Outcome; Oxidative Stress; Parents; Participant; Patient Self-Report; Perception; Persons; Physiological; Pilot Projects; Process; Program Development; Psychosocial Factor; Quality of life; Randomized; Recommendation; Records; Regimen; Research; Risk; Self Efficacy; Series; Source; Structure; Testing; Youth; base; behavior change; cardiovascular risk factor; clinical practice; design; diabetes control; diabetes management; efficacy trial; expectation; fruits and vegetables; glucose monitor; glycemic control; improved; intervention effect; knowledge base; nutrition; peer; primary outcome; psychosocial; response; satisfaction; saturated fat; social; sugar; therapy design

Because degree of diabetes complications is directly linked to level of diabetes control, current diabetes regimens emphasize maintenance of near-normal glycemia through the use of intensive insulin regimens and carbohydrate counting. While moderation in the use of simple sugar is recommended, the source or quality of carbohydrate is not currently considered an integral part of the regimen. However, a growing body of evidence indicates that carbohydrates with a lower glycemic index may reduce postprandial hyperglycemia and improve overall glycemic control. Such a diet would consist of greater consumption of carbohydrate from nutrient-dense whole foods - whole grains, fruits, vegetables, and legumes - in accordance with the HHS-USDA 2005 Dietary Guidelines for Americans. Concurrently, children with type 1 diabetes are consuming diets low in fruits, vegetables, and whole grains, and high in saturated fat. This poor diet quality is particularly concerning due to the increased risk of dyslipidemia and cardiovascular disease and high the high prevalence of cardiovascular risk factors recently observed in youth with diabetes. Two pilot studies have provided data to guide the development of this program of research. A pilot study was conducted during the summer of 2004 to investigate the feasibility and acceptability of implementing a low glycemic index diet in the diabetes camp setting. Camp provides an ideal setting to introduce youth to a lower glycemic index diet, because exposure to foods is controlled, and a sufficient number of meals are served to assess acceptability across a range of foods. Youth ages 7 to 15 attending a diabetes summer camp were served standard diabetes camp menus and lower glycemic index diabetes camp menus in a daily alternating cross-over design. Measures of satisfaction with the camp meals and snacks were obtained from youth and staff, and observations of meal consumption were conducted. Additional data were collected via focus groups, and self-report of food patterns and preferences. Meal plans and blood glucose monitoring data were obtained from camp records. A pilot study was conducted during the summer of 2006 testing blood glucose response to low and high glycemic index meals in youth with diabetes using continuous blood glucose monitoring. In this study, youth with diabetes participated in 5 days of continuous blood glucose monitoring during which they received both low and high glycemic index meals both in a structured clinic setting and in the home environment. Food intake, insulin, and blood glucose self-monitoring were recorded. Analyses are in progress, and include comparison of mean blood glucose, excursions, and variability. A series of focus groups addressed perceptions of healthful eating among families of children with type 1 diabetes to guide development of a behavioral intervention to be testing in the upcoming efficacy trial. The focus groups were conducted separately with children, adolescents, and parents. In addition, a cross-sectional observational study assessing potential modifiable factors associated with dietary intake was conducted. Data collected include child and parent dietary intake, family eating patterns, food availability, nutrition knowledge, parent and child beliefs regarding healthful eating (e.g., barriers, outcome expectations, self-efficacy), and parent and peer modeling of healthful eating. An efficacy trial of a behavioral intervention designed to increase consumption of carbohydrates from lower glycemic, nutrient dense, whole food sources is underway. The purpose of this trial is to determine the efficacy of a behavioral nutrition intervention for children with type 1 diabetes ages 8 to 16 and their families. The goal of the intervention is to increase the consumption of carbohydrates from low glycemic index, nutrient-dense whole foods (i.e., fruits, vegetables, whole grains, legumes). The effect of the dietary intervention on glycemic control and other diabetes-specific outcomes (e.g., glycemic excursions, insulin dose and frequency of hypoglycemia), body composition, lipid profiles, oxidative stress and inflammation will be determined. In addition, effects of the intervention on psychosocial factors (e.g., quality of life and disordered eating behaviors) will be investigated. Families were randomized to either a behavioral nutrition intervention or a control condition. Participants in both groups use episodic masked continuous glucose monitoring (CGM) at predetermined intervals during the study. Participants in the control condition receive usual diabetes care, including general diabetes-related education promoting a healthy lifestyle. Participants in the behavioral nutrition intervention participate in a series of family-based sessions during the first 12 months of the study. These sessions will use behavioral techniques and educational content to promote increased consumption of carbohydrates from low glycemic index, nutrient-dense whole foods, and decreased consumption of highly processed carbohydrate-containing foods. Additional booster contacts occur for the following 6 months of the study. Dietary intake, social and cognitive mediators, and health outcomes are assessed at baseline, 6 months, 12 months, and 18 months. Primary outcomes are dietary quality and hemoglobin A1c, an established measure of glycemic control. It is anticipated that this research will provide data that are critical for guiding dietary guidelines for persons with diabetes. Findings will advance understanding of: 1) the efficacy of behavioral interventions for youth with diabetes designed to increase consumption of whole grains, fruits, vegetables, and legumes; 2) mediators and moderators of behavior change; and 3) physiological effects of dietary change. Dietary recommendations for persons with diabetes must take into account both the potential benefits dietary change, as well as the feasibility, acceptability, and expected difficulty of implementing such recommendations. Studies to date have relied primarily on either experimental manipulation or traditional dietary education to achieve dietary change, and so provide inadequate information to guide clinical practice with free-living individuals. Thus, findings from this study will address areas that are currently lacking in the knowledge base.

由于糖尿病并发症的程度与糖尿病控制水平直接相关，因此当前的糖尿病治疗方案强调通过使用强化胰岛素治疗方案和碳水化合物计数来维持接近正常的血糖。虽然建议适量使用单糖，但碳水化合物的来源或质量目前并不被认为是该疗法的一个组成部分。然而，越来越多的证据表明，血糖指数较低的碳水化合物可以减少餐后高血糖并改善整体血糖控制。根据 HHS-USDA 2005 年美国人膳食指南，这种饮食将包括更多地摄入营养丰富的天然食品（全谷物、水果、蔬菜和豆类）中的碳水化合物。 与此同时，患有 1 型糖尿病的儿童的饮食中水果、蔬菜和全谷物含量较低，而饱和脂肪含量较高。 由于血脂异常和心血管疾病的风险增加，以及最近在糖尿病青少年中观察到的心血管危险因素的高患病率，这种不良的饮食质量尤其令人担忧。 两项试点研究提供了数据来指导该研究计划的发展。 2004 年夏天进行了一项试点研究，以调查在糖尿病营环境中实施低血糖指数饮食的可行性和可接受性。营地为向青少年介绍较低血糖指数饮食提供了理想的环境，因为食物的接触受到控制，并且提供足够数量的膳食以评估各种食物的可接受性。参加糖尿病夏令营的 7 至 15 岁青少年以每日交替交叉设计的方式获得标准糖尿病夏令营菜单和较低血糖指数糖尿病夏令营菜单。青少年和工作人员对营地膳食和小吃的满意度进行了测量，并对膳食消耗进行了观察。通过焦点小组以及食物模式和偏好的自我报告收集了更多数据。膳食计划和血糖监测数据来自营地记录。 2006 年夏天进行了一项试点研究，使用连续血糖监测来测试患有糖尿病的青少年对低血糖指数和高血糖指数膳食的血糖反应。在这项研究中，患有糖尿病的青少年参加了为期 5 天的连续血糖监测，在此期间他们在结构化诊所环境和家庭环境中接受低血糖指数和高血糖指数膳食。记录食物摄入量、胰岛素和血糖自我监测。分析正在进行中，包括平均血糖、偏差和变异性的比较。 一系列焦点小组讨论了 1 型糖尿病儿童家庭对健康饮食的看法，以指导制定行为干预措施，并在即将进行的疗效试验中进行测试。 焦点小组分别与儿童、青少年和家长进行。 此外，还进行了一项横断面观察研究，评估与饮食摄入相关的潜在可改变因素。收集的数据包括儿童和家长的饮食摄入量、家庭饮食模式、食物供应情况、营养知识、家长和儿童对健康饮食的信念（例如障碍、结果期望、自我效能）以及健康饮食的家长和同伴模型。 一项行为干预的功效试验正在进行中，该行为干预旨在增加低血糖、营养丰富的天然食物来源中碳水化合物的摄入量。 该试验的目的是确定行为营养干预对 8 至 16 岁 1 型糖尿病儿童及其家人的疗效。 干预的目标是增加低血糖指数、营养丰富的天然食品（即水果、蔬菜、全谷物、豆类）中碳水化合物的摄入量。 将确定饮食干预对血糖控制和其他糖尿病特异性结果（例如血糖波动、胰岛素剂量和低血糖频率）、身体成分、血脂、氧化应激和炎症的影响。 此外，还将调查干预措施对社会心理因素（例如生活质量和饮食失调行为）的影响。 家庭被随机分配接受行为营养干预或对照条件。 两组参与者在研究期间按预先确定的时间间隔使用间歇性隐蔽连续血糖监测 (CGM)。 对照组的参与者接受常规的糖尿病护理，包括促进健康生活方式的一般糖尿病相关教育。 行为营养干预的参与者在研究的前 12 个月内参加了一系列以家庭为基础的会议。 这些课程将使用行为技巧和教育内容来促进增加低血糖指数、营养丰富的天然食品中碳水化合物的消费，并减少高度加工的含碳水化合物食品的消费。 在接下来的 6 个月研究中会发生额外的加强接触。 在基线、6 个月、12 个月和 18 个月时评估饮食摄入量、社会和认知调节因素以及健康结果。 主要结果是饮食质量和糖化血红蛋白（血糖控制的既定指标）。 预计这项研究将提供对于指导糖尿病患者饮食指南至关重要的数据。研究结果将增进对以下方面的理解：1）旨在增加全谷物、水果、蔬菜和豆类消费的行为干预措施对患有糖尿病的青少年的有效性； 2）行为改变的调解者和调节者； 3）饮食变化的生理影响。针对糖尿病患者的饮食建议必须考虑饮食改变的潜在益处，以及实施此类建议的可行性、可接受性和预期难度。迄今为止的研究主要依靠实验操作或传统饮食教育来实现饮食改变，因此无法提供足够的信息来指导自由生活个体的临床实践。因此，这项研究的结果将解决目前知识库中缺乏的领域。