Enhancing Carbohydrate Quality in Diabetes Management

1型糖尿病儿童的营养指南与一般人群的营养指南相似，1型糖尿病儿童家庭的营养教育包括一般健康饮食的建议以及实现和保持身高最佳体重的努力。目前的治疗标准强调生理性胰岛素替代;因此，1型糖尿病医学营养治疗的主要组成部分是碳水化合物估计，因为碳水化合物是影响血糖波动的主要常量营养素。一个主要的重点是将胰岛素方案和碳水化合物估计纳入家庭的生活方式，符合首选的饮食习惯，食物选择和体育活动模式。与此同时，患有1型糖尿病的儿童正在食用水果，蔬菜和全谷物含量低，饱和脂肪含量高的饮食。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年中观察到的心血管风险因素的高患病率，饮食质量差尤其令人担忧。有限的研究已经检查了1型糖尿病患者的日常饮食摄入和糖尿病管理之间的关系。然而，越来越多的证据表明，饮食摄入，特别是碳水化合物的质量，可能会影响血糖控制，胰岛素需求和体重管理。这项研究探讨了1型糖尿病青年饮食摄入的决定因素，并测试了改善这一人群饮食质量的策略的有效性。 对291名1型糖尿病青年家庭进行了与饮食行为相关的心理社会因素的横断面研究。资料来源包括病历摘要、青少年家长访谈、青少年自我报告调查、青少年家长自我报告调查、青少年3天饮食记录、家长食物频率问卷。研究结果表明，1型糖尿病青年的水果蔬菜和全谷物摄入量低，整体饮食质量差，并表明饮食摄入量的儿童和家庭决定因素可能是可改变的。 一项临床试验测试了一种以家庭为基础的行为干预的效果，这种干预旨在通过促进水果、蔬菜、全谷物、豆类、坚果和种子的摄入来改善饮食质量。将136个家庭随机分为两组，一组进行包括动态血糖监测反馈的行为营养干预，另一组仅进行动态血糖监测反馈。干预方法以社会认知理论、自我调节和自我决定理论为基础，将动机访谈、主动学习和应用问题解决结合起来，以增加水果、蔬菜、全谷物、豆类、坚果和种子的饮食摄入量为目标。收集的数据包括医疗记录摘要，父母-青少年访谈，青少年自我报告调查，父母自我报告调查，青少年3天饮食记录，父母3天饮食记录，青少年连续葡萄糖监测，青少年身体成分（DXA）和青少年生物标志物，包括脂质，类胡萝卜素和炎症和氧化应激标志物。主要结果包括饮食摄入和血糖控制。

Nutrition guidelines for children with type 1 diabetes are similar to those for the general population, and nutrition education for families of children with type 1 diabetes includes recommendations for general healthful eating and efforts to achieve and maintain optimal weight for height. Current treatment standards emphasize physiologic insulin replacement; therefore, a primary component of medical nutrition therapy in type 1 diabetes is carbohydrate estimation, as carbohydrates are the principal macronutrient affecting glycemic excursions. A major focus is on integrating the insulin regimen and carbohydrate estimation into the familys lifestyle, conforming to preferred meal routines, food choices, and physical activity patterns. Concurrently, children with type 1 diabetes are consuming diets low in fruits, vegetables, and whole grains, and high in saturated fat. Poor diet quality is particularly concerning due to the increased risk of dyslipidemia and cardiovascular disease and the high prevalence of cardiovascular risk factors recently observed in youth with diabetes. Limited research has examined relations between usual dietary intake and diabetes management in type 1 diabetes. However, there is a growing body of evidence indicating that dietary intake, particularly carbohydrate quality, may affect blood sugar control, insulin demand, and weight management. This research examines determinants of dietary intake among youth with type 1 diabetes and tests the efficacy of strategies to improve diet quality in this population. A cross-sectional study of psychosocial factors related to eating behaviors was conducted in 291 families with youth with type 1 diabetes. Data were obtained using medical record abstraction, parent-youth interview, youth self-report surveys, parent self-report surveys, youth 3-day diet records, parent food frequency questionnaire. Findings document low intake of fruit vegetables, and whole grains, and poor overall diet quality among youth with type 1 diabetes, and indicate potentially modifiable child and family determinants of dietary intake. A clinical trial tests the efficacy a family-based behavioral intervention designed to improve diet quality by promoting intake of fruit, vegetables, whole grains, legumes, nuts, and seeds. A sample of 136 families was randomized to the behavioral nutrition intervention including continuous glucose monitoring feedback or to continuous glucose monitoring feedback only. The intervention approach, which is grounded in social cognitive theory, self-regulation, and self-determination theory, integrates motivational interviewing, active learning, and applied problem-solving to target increased dietary intake of fruits, vegetables, whole grains, legumes, nuts, and seeds. Data collected include medical record abstraction, parent-youth interview, youth self-report surveys, parent self-report surveys, youth 3-day diet records, parent 3-day diet records, youth continuous glucose monitoring, youth body composition (DXA), and youth biomarkers including lipids, carotenoids, and markers of inflammation and oxidative stress. Primary outcomes include dietary intake and glycemic control.