Enhancing Carbohydrate Quality in Diabetes Management

1型糖尿病儿童的营养指南与普通人群的营养指南类似，针对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，以及努力实现和保持最佳身高体重。目前的治疗标准强调生理性胰岛素替代；因此，1型糖尿病的医疗营养治疗的一个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漂移的主要常量营养素。一个主要的重点是将胰岛素方案和碳水化合物评估整合到家庭的生活方式中，符合首选的饮食习惯、食物选择和体力活动模式。与此同时，1型糖尿病儿童的饮食中水果、蔬菜和全谷物含量较低，饱和脂肪含量较高。饮食质量差尤其令人担忧，因为患血脂异常和心血管疾病的风险增加，以及最近在患有糖尿病的青年中观察到的心血管危险因素的高患病率。有限的研究考察了1型糖尿病患者日常饮食摄入量与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。这项研究调查了1型糖尿病青年饮食摄入量的决定因素，并测试了改善这一人群饮食质量的策略的有效性。 对291例青年1型糖尿病患者家庭饮食行为的心理社会因素进行了横断面研究。采用病历摘录、亲子访谈、青少年自述调查、父母自述调查、青少年3日饮食记录、父母饮食频率问卷等方法获取数据。研究结果证明，患有1型糖尿病的青少年水果、蔬菜和全谷物的摄入量较低，总体饮食质量较差，并表明儿童和家庭饮食摄入量的决定因素可能是可改变的。 一项临床试验测试了这种基于家庭的行为干预的有效性，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。随机抽取136个家庭进行行为营养干预，包括连续血糖监测反馈和单纯连续血糖监测反馈。这种以社会认知理论、自我调节和自我决定理论为基础的干预方法，融合了动机访谈、主动学习和应用问题解决的方法，以增加水果、蔬菜、全谷类、豆类、坚果和种子的饮食摄入量。收集的数据包括病历摘要、亲子访谈、青年自我报告调查、父母自我报告调查、青年3天饮食记录、父母3天饮食记录、青年连续血糖监测、青年身体成分(DXA)，以及青年生物标记物，包括血脂、类胡萝卜素、炎症和氧化应激标志物。主要结果包括饮食摄入量和血糖控制。

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.