ENHANCING CARBOHYDRATE QUALITY IN DIABETES TYPE - 1

由于糖尿病并发症的程度与糖尿病控制水平直接相关，因此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。 这项研究将测试一项创新的干预计划，旨在促进从营养丰富的全食品中消费低血糖碳水化合物，并确定这种饮食变化在促进1型糖尿病儿童和青少年改善血糖控制和健康结果方面的功效。目标包括评估行为干预在促进饮食习惯长期变化方面的功效，以及饮食习惯的社会和认知介导因素，以及这些饮食习惯在促进改善血糖控制和其他健康状况指标方面的短期和长期功效。 具体目标（不超过1页，不得公开） 这项研究的具体目标包括： 1)在1型糖尿病青年中，确定行为干预在促进以下方面的疗效： a.改变饮食习惯的社会和认知媒介; B.改变家庭饮食模式; C.通过膳食报告和血清类胡萝卜素评估，水果、蔬菜、全谷物和豆类的消费量增加; D.根据膳食报告评估，精制碳水化合物的消耗量减少; e.饮食血糖指数降低; F.饮食营养密度的增加。 2)确定有针对性的饮食改变对糖尿病结局的疗效，包括： a.通过HbA 1c和1，5-脱水葡萄糖醇评估的总体血糖控制; B.通过连续血糖监测曲线评估的血糖波动/血糖变异性; C.胰岛素剂量; D.低血糖的频率。 3)确定这些饮食习惯对身体组成，脂质分布，氧化应激和炎症的影响。 4)确定饮食干预和随后的饮食改变对心理社会状态的影响，包括生活质量、对低血糖的恐惧、饮食行为紊乱和对糖尿病饮食管理的满意度。 次要和观察性研究问题包括以下内容： 1

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