Enhancing Carbohydrate Quality in Diabetes Management

针对1型糖尿病儿童的营养指南与针对一般人群的营养指南相似，针对1型糖尿病儿童家庭的营养教育包括建议一般健康饮食和努力达到并保持最佳体重与身高的比例。目前的治疗标准强调生理性胰岛素替代；因此，1型糖尿病医学营养治疗的一个主要组成部分是碳水化合物的估计，因为碳水化合物是影响血糖漂移的主要常量营养素。一个主要的焦点是将胰岛素治疗方案和碳水化合物评估纳入家庭生活方式，符合首选的饮食习惯，食物选择和身体活动模式。与此同时，患有1型糖尿病的儿童的饮食中水果、蔬菜和全谷物含量低，饱和脂肪含量高。由于血脂异常和心血管疾病的风险增加，以及最近在青年糖尿病患者中观察到的心血管危险因素的高流行率，饮食质量差尤其令人担忧。有限的研究调查了1型糖尿病患者日常饮食摄入与糖尿病管理之间的关系。然而，越来越多的证据表明，饮食摄入，尤其是碳水化合物的质量，可能会影响血糖控制、胰岛素需求和体重管理。本研究探讨了青少年1型糖尿病患者饮食摄入的决定因素，并测试了改善这一人群饮食质量的策略的有效性。

Nutrition guidelines for children with type 1 diabetes are similar to those for the general population, and nutrition education for families of children with type 1 diabetes includes recommendations for general healthful eating and efforts to achieve and maintain optimal weight for height. Current treatment standards emphasize physiologic insulin replacement; therefore, a primary component of medical nutrition therapy in type 1 diabetes is carbohydrate estimation, as carbohydrates are the principal macronutrient affecting glycemic excursions. A major focus is on integrating the insulin regimen and carbohydrate estimation into the familys lifestyle, conforming to preferred meal routines, food choices, and physical activity patterns. Concurrently, children with type 1 diabetes are consuming diets low in fruits, vegetables, and whole grains, and high in saturated fat. Poor diet quality is particularly concerning due to the increased risk of dyslipidemia and cardiovascular disease and the high prevalence of cardiovascular risk factors recently observed in youth with diabetes. Limited research has examined relations between usual dietary intake and diabetes management in type 1 diabetes. However, there is a growing body of evidence indicating that dietary intake, particularly carbohydrate quality, may affect blood sugar control, insulin demand, and weight management. This research examines determinants of dietary intake among youth with type 1 diabetes and tests the efficacy of strategies to improve diet quality in this population. A cross-sectional study of psychosocial factors related to eating behaviors was conducted in 291 families with youth with type 1 diabetes. Data were obtained using medical record abstraction, parent-youth interview, youth self-report surveys, parent self-report surveys, youth 3-day diet records, parent food frequency questionnaire. Findings document low intake of fruit vegetables, and whole grains, and poor overall diet quality among youth with type 1 diabetes, and indicate potentially modifiable child and family determinants of dietary intake. A clinical trial tests the efficacy a family-based behavioral intervention designed to improve diet quality by promoting intake of fruit, vegetables, whole grains, legumes, nuts, and seeds. A sample of 139 families was randomized to the behavioral nutrition intervention including continuous glucose monitoring feedback or to continuous glucose monitoring feedback only. The intervention approach, which is grounded in social cognitive theory, self-regulation, and self-determination theory, integrates motivational interviewing, active learning, and applied problem-solving to target increased dietary intake of fruits, vegetables, whole grains, legumes, nuts, and seeds. Data collected include medical record abstraction, parent-youth interview, youth self-report surveys, parent self-report surveys, youth 3-day diet records, parent 3-day diet records, youth continuous glucose monitoring, youth body composition (DXA), and youth biomarkers including lipids, carotenoids, and markers of inflammation and oxidative stress. Primary outcomes include dietary intake and glycemic control.