ENHANCING CARBOHYDRATE QUALITY IN DIABETES TYPE - 1

提高 1 型糖尿病患者的碳水化合物质量

• 批准号: 7943299
• 负责人: LORI LAFFEL
• 金额: $ 94.3万
• 依托单位: JOSLIN DIABETES CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-06-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7943299
• 关键词: ENHANCING; CARBOHYDRATE; QUALITY; DIABETES; TYPE

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

由于糖尿病并发症的程度直接关系到糖尿病的控制水平，目前的糖尿病治疗方案越来越重视通过使用更密集的胰岛素方案和碳水化合物计数来维持接近正常的血糖。虽然建议适量使用单糖，但碳水化合物的来源或质量目前并不被视为养生法的组成部分。然而，越来越多的证据表明，血糖指数较低的碳水化合物可能会降低餐后高血糖，并改善整体血糖控制。根据HHS-USDA 2005年美国饮食指南，这样的饮食将包括更多地消费来自全食--全谷物、水果、蔬菜和豆类--的碳水化合物。 这项研究将测试一项旨在促进从营养密集的全食中摄取低血糖碳水化合物的创新干预计划，并确定这种饮食变化在促进1型糖尿病儿童和青少年血糖控制和健康结果方面的有效性。目的包括评估行为干预在促进饮食习惯长期变化方面的有效性，以及饮食做法的社会和认知中介，以及这些饮食做法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效果。 具体目标(不得超过1页) 这项研究的具体目标包括： 1)在患有1型糖尿病的青年中，确定行为干预在促进以下方面的效果： A.饮食习惯的社会和认知中介的变化； B.改变家庭用餐模式； 根据膳食报告和血清类胡萝卜素的评估，水果、蔬菜、全谷物和豆类的消费量增加； D.饮食报告评估的精制碳水化合物消费量的减少； E.饮食中的血糖指数下降； F.增加膳食营养密度。 2)确定有针对性的饮食改变对糖尿病结局的效果，包括： A.糖化血红蛋白和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漂移/血糖变异性； C.胰岛素剂量； D.低血糖的发生频率。 3)确定这些饮食实践对身体成分、血脂、氧化应激和炎症的效果。 4)确定饮食干预和随后的饮食改变对心理社会状况的影响，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。 次级和观察性研究问题包括以下问题： 1