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Enhancing Carbohydrate Quality in Diabetes Management

提高糖尿病管理中的碳水化合物质量

基本信息

批准号：
7734804
负责人：
Tonja Nansel
金额：
$ 19.97万
依托单位：
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
依托单位国家：
美国
项目类别：
财政年份：
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/7734804
关键词：
Accounting Address Adolescent Age American Area Behavior Therapy Belief Blood Glucose Blood Glucose Self-Monitoring Camping Carbohydrates Child Clinic Clinical Cognitive Complications of Diabetes Mellitus Consumption Count Crossover Design Daily Data Development Diabetes Mellitus Diet Dietary Fiber Dietary Practices Dietary intake Eating Education Exposure to Fabaceae Family Focus Groups Food Food Patterns Glycemic Index Guidelines Health Health Status Indicators Home environment Hyperglycemia Individual Insulin Insulin-Dependent Diabetes Mellitus Knowledge Life Link Maintenance Measures Mediator of activation protein Modeling Numbers Nutrient Observational Study Outcome Parents Patient Self-Report Perception Persons Physiological Pilot Projects Program Development Range Recommendation Records Research Self Efficacy Series Source Standards of Weights and Measures Structure Testing Treatment Protocols Youth behavior change day design diabetes management efficacy trial expectation fruits and vegetables glucose monitor glycemic control improved knowledge base nutrition peer preference response satisfaction social sugar therapy design

项目摘要

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 nutrient-dense 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. 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 is in progress. 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. 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 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 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密集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。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未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减少餐后高血糖并改善整体血糖控制。按照美国卫生和农业部2005年《美国人膳食指南》，这种饮食将包括从营养丰富的天然食品中摄入更多的碳水化合物——全谷物、水果、蔬菜和豆类。