ENHANCING CARBOHYDRATE QUALITY IN DIABETES TYPE - 1

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Because the degree of diabetes complications is directly linked to the 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. This study will test an innovative program of interventions designed to promote consumption of lower glycemic carbohydrates from nutrient-dense whole foods and to determine the efficacy of such a dietary change in promoting improved glycemic control and health outcomes among children and adolescents with type 1 diabetes. Objectives include the assessment of the efficacy of behavioral intervention in promoting long-term change in dietary practices, and social and cognitive mediators of dietary practices, as well as the short- and long-term efficacy of these dietary practices in promoting improved glycemic control and other indicators of health status. Specific Aims (no longer than 1 page¿not to be made public) Specific aims of this study include the following: 1) Among youth with type 1 diabetes, determine the efficacy of behavioral intervention in promoting: a. change in social and cognitive mediators of dietary practices; b. change in family meal patterns; c. an increase in consumption of fruits, vegetables, whole grains, and legumes, as assessed by dietary report and serum carotenoids; d. a decrease in consumption of refined carbohydrates as assessed by dietary report; e. a decrease in dietary glycemic index; f. an increase in dietary nutrient density. 2) Determine the efficacy of the targeted dietary changes on diabetes outcomes, including: a. overall glycemic control, as assessed by HbA1c and 1,5-anhydroglucitol; b. glycemic excursions / blood glucose variability, as assessed by continuous blood glucose monitoring profiles; c. insulin dose; d. frequency of hypoglycemia. 3) Determine the efficacy of these dietary practices on body composition, lipid profiles, oxidative stress, and inflammation. 4) Determine the influence of the dietary intervention and subsequent dietary change on psychosocial status including quality of life, fear of hypoglycemia, disordered eating behaviors, and satisfaction with diabetes dietary management. Secondary and observational research questions include the following: 1