July 2008 - A study by researchers at the Joslin Diabetes Center has shown that adherence to prescribed dietary recommendations is associated with better glucose control in children with type 1 diabetes.
"In recent years, diabetes management has been focused around new medications and technologies," said Lori Laffel, M.D., senior author of the paper, which is published in the July issue of Diabetes Care. "In this study, we were encouraged to identify the unique importance of diet on blood sugar control in children and teens with type 1 diabetes."
Laffel is Chief of Joslin Diabetes Center's Pediatric, Adolescent and Young Adult Section and an Investigator in the Joslin Section on Genetics and Epidemiology.
The study surveyed the parents of 119 children and teens ages 9-14 years and asked how closely they followed prescribed dietary behaviors, such as estimating carbohydrate intake, matching the child's insulin dose to carbohydrate intake and the quality of the diet itself, in terms of intake of sweets and fats.
Subjects who most closely adhered to the dietary recommendations had lower A1C levels � a measurement of average blood glucose deemed the best way to estimate overall glucose control. Lower A1C levels mean better glucose control.
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Children who adhered closely or fairly closely to the prescribed dietary recommendations showed an A1C level of up to almost a full point lower than those who were least adherent. Those who adhered the least had an average A1C of 9 percent, while those who adhered more closely to the recommendations had an average A1C between 8.1 and 8.4 percent, depending on their level of adherence.
The A1C difference of between 0.6 and 0.9 is considered significant, according to Sanjeev Mehta, M.D., lead author and a Joslin staff physician and research associate, who noted that lowering A1C scores is associated with a significant reduction in risk of diabetes-related complications.
"By achieving target A1C levels, the long-term risk of complications can be reduced by 50 to 75 percent," he said. "For every point you lower your A1C score, the risk is reduced further."
Mehta said the study's demonstration that dietary behaviors are directly associated with glycemic control provides families with another avenue through which they can optimize their children's diabetes management. He noted that this study highlights the importance of dietary adherence in achieving optimal glucose control in the era where more youth with type 1 diabetes are using new technologies, such as insulin pumps and rapid acting insulin.
"The relative importance of dietary behaviors in diabetes management had not been investigated in this current era," he said.
The paper concluded: "Dietary adherence may represent an important modifiable factor in the treatment of youth with type 1 diabetes. In this era of intensive management, future interventions aimed at increasing diabetes-specific dietary adherence may improve glycemic control in this population."
The study was funded by the National Institute of Child Health and Human Development (NICHD). Other researchers participating in the study included Lisa K. Volkening at Joslin; Barbara J. Anderson of Texas Children's Hospital; Tonja Nansel of NICHD; Jill Weissberg-Benchell of Children's Memorial Hospital, Chicago; and Tim Wysocki of Nemours Children's Clinic, Jacksonville, FL.
Source: Joslin Diabetes Center
