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: 7594255
• 负责人: Tonja Nansel
• 金额: $ 27.32万
• 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/7594255
• 关键词: Accounting; Address; Adolescent; Age; American; Area; Behavior Therapy; Blood Glucose; Blood Glucose Self-Monitoring; Camping; Carbohydrates; Child; Clinic; Clinical; Cognitive; Complications of Diabetes Mellitus; Consumption; Count; Crossover Design; Daily; Data; Diabetes Mellitus; Diet; Dietary Fiber; Dietary Practices; Eating; Education; Exposure to; Fabaceae; Focus Groups; Food; Food Patterns; Glycemic Index; Guidelines; Health; Health Status Indicators; Home environment; Hyperglycemia; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Life; Link; Maintenance; Measures; Mediator of activation protein; Numbers; Nutrient; Outcome; Patient Self-Report; Persons; Physiological; Pilot Projects; Program Development; Range; Recommendation; Records; Research; Source; Standards of Weights and Measures; Structure; Testing; Treatment Protocols; Youth; behavior change; day; design; diabetes management; efficacy trial; fruits and vegetables; glucose monitor; glycemic control; improved; innovation; knowledge base; preference; programs; response; satisfaction; social; sugar; therapy design

Because degree of diabetes complications is directly linked to level of diabetes control, current diabetes regimens are placing increasing emphasis on maintenance of near-normal glycemia through the use of more 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 whole foods - whole grains, fruits, vegetables, and legumes - in accordance with the HHS-USDA 2005 Dietary Guidelines for Americans. 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. Planning is underway for the conduct of an efficacy trial of a behavioral intervention designed to increase consumption of carbohydrates from lower glycemic, nutrient dense, whole food sources. 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 of a lower glycemic index diet, 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 little 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，目前的糖尿病治疗方案越来越强调通过使用更强化的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水平。虽然建议适度使用单糖，但碳水化合物的来源或质量目前并不被认为是该方案的组成部分。然而，越来越多的证据表明，具有较低血糖指数的碳水化合物可以降低餐后高血糖，改善总体血糖控制。根据HHS-USDA 2005年美国人膳食指南，这样的饮食将包括从全食物-全谷物，水果，蔬菜和豆类-中摄入更多的碳水化合物。 两项试点研究提供了数据，以指导这一研究方案的发展。 2004年夏天进行了一项试点研究，以调查在糖尿病营地环境中实施低血糖指数饮食的可行性和可接受性。营地提供了一个理想的环境，介绍青年到一个较低的血糖指数饮食，因为接触的食物是控制，并提供足够数量的膳食，以评估在一系列食物的可接受性。参加糖尿病夏令营的7至15岁的青少年每天交替交叉设计提供标准糖尿病夏令营菜单和低血糖指数糖尿病夏令营菜单。从青年和工作人员那里获得了对营地膳食和小吃的满意度，并对膳食消费进行了观察。通过焦点小组和食物模式和偏好的自我报告收集了其他数据。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，青年糖尿病患者参加了5天的连续血糖监测，在此期间，他们在结构化的诊所环境和家庭环境中接受了低血糖指数和高血糖指数的膳食。记录食物摄入、胰岛素和血糖自我监测。分析正在进行中，包括平均血糖、波动和变异性的比较。 正在计划进行一项行为干预的有效性试验，旨在从低血糖、营养密集的全食物来源中增加碳水化合物的摄入。 预计这项研究将提供指导糖尿病患者饮食指南的关键数据。研究结果将促进对以下问题的理解：1）旨在增加全谷物，水果，蔬菜和豆类消费的糖尿病青少年行为干预措施的有效性; 2）行为变化的中介者和调节者;以及3）饮食变化的生理影响。糖尿病患者的饮食建议必须考虑到低血糖指数饮食的潜在益处，以及实施这些建议的可行性，可接受性和预期难度。迄今为止的研究主要依赖于实验操作或传统的饮食教育来实现饮食改变，因此提供的信息很少，以指导临床实践与自由生活的个人。因此，这项研究的结果将涉及目前知识库中缺乏的领域。