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Bjornstad P, Dart A, Donaghue KC, Dost A, Feldman EL, Tan GS, Wadwa RP, Zabeen B, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Microvascular and macrovascular complications in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1432-1450. [PMID: 36537531 DOI: 10.1111/pedi.13444] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Allison Dart
- Department of Pediatrics, Divison of Nephrology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim C Donaghue
- Department of Pediatrics, Division of Endocrinology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Axel Dost
- Department of Pediatrics, Division of Endocrinology, Jena University Hospital, Jena, Germany
| | - Eva L Feldman
- Department of Medicine, Division of Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - R Paul Wadwa
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge, and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, Baptista J, Chinchilla P, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1297-1321. [PMID: 36468223 DOI: 10.1111/pedi.13429] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- S Francesca Annan
- Paediatric Division, University College London Hospitals, London, UK
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Elisabeth Jelleryd
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara Hannon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shelley Rose
- Diabetes & Endocrinology Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, India
| | | | - Paula Chinchilla
- Women's and Children's Department, London North West Healthcare NHS Trust, London, UK
| | - Maria Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
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Granado-Casas M, Solà I, Hernández M, Rojo-López MI, Julve J, Mauricio D. Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review. Nutr Diabetes 2022; 12:24. [PMID: 35459205 PMCID: PMC9033775 DOI: 10.1038/s41387-022-00201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment. OBJECTIVES Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes. METHODS The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance. RESULTS From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI. CONCLUSIONS Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.
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Affiliation(s)
- Minerva Granado-Casas
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041, Barcelona, Spain
- Center for Biomedical Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marina Idalia Rojo-López
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
- Faculty of Medicine, University of Vic (UVIC/UCC), Vic, Spain.
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Jiménez-Sánchez A, Martínez-Ortega AJ, Remón-Ruiz PJ, Piñar-Gutiérrez A, Pereira-Cunill JL, García-Luna PP. Therapeutic Properties and Use of Extra Virgin Olive Oil in Clinical Nutrition: A Narrative Review and Literature Update. Nutrients 2022; 14:nu14071440. [PMID: 35406067 PMCID: PMC9003415 DOI: 10.3390/nu14071440] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
Extra virgin olive oil (EVOO) is a cornerstone of the Mediterranean diet (MedD). In this narrative review, we synthesize and illustrate the various characteristics and clinical applications of EVOO and its components—such as oleic acid, hydroxytyrosol, and oleuropein—in the field of clinical nutrition and dietetics. The evidence is split into diet therapy, oleic acid-based enteral nutrition formulations and oral supplementation formulations, oleic acid-based parenteral nutrition, and nutraceutical supplementation of minor components of EVOO. EVOO has diverse beneficial health properties, and current evidence supports the use of whole EVOO in diet therapy and the supplementation of its minor components to improve cardiovascular health, lipoprotein metabolism, and diabetes mellitus in clinical nutrition. Nevertheless, more intervention studies in humans are needed to chisel specific recommendations for its therapeutic use through different formulations in other specific diseases and clinical populations.
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Affiliation(s)
- Andrés Jiménez-Sánchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Correspondence: (A.J.-S.); (P.P.G.-L.)
| | - Antonio Jesús Martínez-Ortega
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Torrecárdenas, C. Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Pablo Jesús Remón-Ruiz
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - Ana Piñar-Gutiérrez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - José Luis Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - Pedro Pablo García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Correspondence: (A.J.-S.); (P.P.G.-L.)
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Dominguez-Riscart J, Buero-Fernandez N, Garcia-Zarzuela A, Morales-Perez C, Garcia-Ojanguren A, Lechuga-Sancho AM. Adherence to Mediterranean Diet Is Associated With Better Glycemic Control in Children With Type 1 Diabetes: A Cross-Sectional Study. Front Nutr 2022; 9:813989. [PMID: 35308270 PMCID: PMC8931736 DOI: 10.3389/fnut.2022.813989] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/18/2022] [Indexed: 01/05/2023] Open
Abstract
Type 1 diabetes (T1D) is a chronic condition, with increased morbidity and mortality, due to a higher rate of cardiovascular disease among other factors. Cardiovascular risk increases with the worse glycemic profile. Nutrition has a deep impact on diabetes control. Adherence to the Mediterranean diet (MD) has been shown to decrease cardiovascular risk in children and adults with obesity and adults with type 2 diabetes, but its impact on T1D children has been scarcely analyzed. We hypothesized that the degree of adherence to MD could relate to the increased time in range in children with T1D.Patients and MethodsCross-sectional analysis involving two university hospitals. We measured the adherence to MD with the Mediterranean Diet Quality Index for children and teenagers (KIDMED) questionnaire, which is a validated tool for this purpose. A score of <5 indicates poor adherence to MD, while a good adherence is indicated by a score of >7. Demographic and clinical data were registered on the same day that the questionnaire was taken, with informed consent. Additionally, the patients' ambulatory glucose profiles (AGPs), were registered from the participants' glucose monitors (continuous or flash devices), and daily insulin needs were recorded from patients' insulin pumps (n=28). Other cardiovascular risk factors such as lipid profile, vitamin D levels, and other biochemical parameters were registered from a blood test, performed 2 weeks before recruitment, as part of the patients' annual screening.ResultsNinety-seven patients (44 girls), with an average age of 11.4 years (± 3.01), were included. Seventy-one of them were on multiple daily injection regimens, and all had either continuous or flash glucose monitoring. Fifty-three had HbA1c levels of <7.5%, while only 21 had a time in range (TIR) of >70%. Contingency analysis showed that the odds of having HbA1c <7.5% increase in children with KIDMED score of >7 (O.R. 2.38; ICR 1.05–5.41; p = 0.036). Moreover, the KIDMED score and the HbA1c levels were negatively correlated (R: −0.245; p-value: 0.001), while the KIDMED score and TIR showed a positive correlation (R: 0.200; p-value: 0.009).ConclusionsOur data suggest that adherence to MD may contribute to better glycemic control in children. This should be taken into account at the time of nutritional education on T1D patients and their families.
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Affiliation(s)
- Jesus Dominguez-Riscart
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Grupo de Inflamación, Nutrición, Metabolismo, y Estrés Oxidativo (INMOX), Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
- *Correspondence: Jesus Dominguez-Riscart
| | - Nuria Buero-Fernandez
- Grupo de Inflamación, Nutrición, Metabolismo, y Estrés Oxidativo (INMOX), Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
- Servicio de Pediatría, Hospital Universitario Puerto Real, Puerto Real, Spain
| | - Ana Garcia-Zarzuela
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Grupo de Inflamación, Nutrición, Metabolismo, y Estrés Oxidativo (INMOX), Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Celia Morales-Perez
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Grupo de Inflamación, Nutrición, Metabolismo, y Estrés Oxidativo (INMOX), Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Ana Garcia-Ojanguren
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Alfonso M. Lechuga-Sancho
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Grupo de Inflamación, Nutrición, Metabolismo, y Estrés Oxidativo (INMOX), Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
- Departmento Materno Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain
- Alfonso M. Lechuga-Sancho
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Cristello Sarteau A, Mayer-Davis E. Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes? Nutrients 2022; 14:nu14040824. [PMID: 35215477 PMCID: PMC8877269 DOI: 10.3390/nu14040824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during this life stage. Nutrition is fundamental to T1D management. We reviewed the evidence base of eating strategies tested to date to improve glycemic levels among youth with T1D in order to identify promising directions for future research. No eating strategy tested among youth with T1D since the advent of flexible insulin regimens—including widely promoted carbohydrate counting and low glycemic index strategies—is robustly supported by the existing evidence base, which is characterized by few prospective studies, small study sample sizes, and lack of replication of results due to marked differences in study design or eating strategy tested. Further, focus on macronutrients or food groups without consideration of food intake distribution throughout the day or day-to-day consistency may partially underlie the lack of glycemic benefits observed in studies to date. Increased attention paid to these factors by future observational and experimental studies may facilitate identification of behavioral targets that increase glycemic predictability and management among youth with T1D.
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Affiliation(s)
- Angelica Cristello Sarteau
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- Correspondence:
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- School of Medicine, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA
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Adherence to the Mediterranean Diet Is Associated with Better Metabolic Features in Youths with Type 1 Diabetes. Nutrients 2022; 14:nu14030596. [PMID: 35276957 PMCID: PMC8840273 DOI: 10.3390/nu14030596] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/01/2023] Open
Abstract
Our aim was to evaluate adherence to the Mediterranean diet (MedDiet) among children and adolescents with type 1 diabetes (T1D) in relation to metabolic control. Adherence to the MedDiet was assessed with the Mediterranean Diet Quality Index (KIDMED) questionnaire and physical activity by the International Physical Activity Questionnaire for Adolescent (IPAQ-A) on 65 subjects (32 males, 9–18 years) with T1D. Clinical and metabolic evaluation was performed (standardized body mass index (BMI-SDS), hemoglobin A1C (HbA1c), continuous glucose monitoring metrics when present, blood pressure, lipid profile). Parental characteristics (age, body mass index (BMI), socio-economic status) were reported. The adherence to the MedDiet was poor in 12.3%, average in 58.6%, and high in 29.1% of the subjects. Furthermore, 23.4% of patients were overweight/obese. The most impacting factors on BMI-SDS were skipping breakfast and their father’s BMI. HbA1c and time in range % were positively associated with sweets and fish intake, respectively. Additionally, the father’s socio-economic status (SES) and mother’s age were associated with glucose control. Blood pressure was associated with travelling to school in vehicles, extra-virgin olive oil intake and milk/dairy consumption at breakfast. The promotion of the MedDiet, mainly having a healthy breakfast, is a good strategy to include in the management of T1D to improve glucose and metabolic control. This research is valuable for parents to obtain the best results for their children with T1D.
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Motamedi M, Ajami G, Mohammadi H, Amirhakimi G, Namdar ZM, Ilkhani H, Moravej H, Aslani A, Amirhakimi A. Uncovering Cardiac Involvement in Childhood Diabetes: Is it Time to Move Toward Speckle Tracking Echocardiography in Childhood Diabetes Management? J Cardiovasc Echogr 2021; 31:165-170. [PMID: 34900552 PMCID: PMC8603770 DOI: 10.4103/jcecho.jcecho_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022] Open
Abstract
Context: One of the most common endocrine disorders in children is diabetes which is the leading cause of premature cardiovascular disease in adulthood. Aims: This study is aimed to investigate the extend of cardiac involvement in diabetic children by speckle tracking echocardiography (STE) in comparison to two-dimensional (2D) echocardiography and routine laboratory data. Settings and Design: A cross-sectional study conducted on patients under 18 years of age who deal with type one diabetes mellitus for more than 5 years. Subjects and Methods: To compare the STE results, we included the STE data of 25 normal age-matched children. All patients underwent laboratory analysis for lipid profile, blood sugar, and 2D echocardiography plus STE. Statistical Analysis Used: Two-sample independent t-test, Chi-square test, logistic regression test, Spearman's rank correlation coefficient, and the Pearson correlation coefficient. Results: From March 2018 to 2019, we included 53 patients, mean age 15.8 ± 0.39 years and 52.8% female, and 25 nondiabetic control in this study. STE revealed global longitudinal strain (LS) −18.4 versus − 24.2 for patient (44 valid cases) versus control group, respectively, with significant statistical difference. Diabetic patients had lower LS in all segments compared to the control group. Conclusions: STE has very high sensitivity to detect cardiac involvement far earlier than 2D echocardiography. None of the routine biomarkers or demographic features can predict cardiac involvement based on segmental abnormalities of STE. Active investigation to clear the remote impact of STE abnormalities and its practical role in childhood diabetes management is highly recommended.
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Affiliation(s)
- Maryam Motamedi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamid Mohammadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Homa Ilkhani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Moravej
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Aslani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anis Amirhakimi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Rubin D, Bosy-Westphal A, Kabisch S, Kronsbein P, Simon MC, Tombek A, Weber K, Skurk T. Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-8766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diana Rubin
- Vivantes Klinikum Spandau, Berlin
- Vivantes Humboldt Klinikum, Berlin
| | - Anja Bosy-Westphal
- Institut für Humanernährung, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Stefan Kabisch
- Deutsches Zentrum für Diabetesforschung (DZD), München
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising
| | - Peter Kronsbein
- Fachbereich Oecotrophologie, Hochschule Niederrhein, Campus Mönchengladbach
| | - Marie-Christine Simon
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | | | - Katharina Weber
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Thomas Skurk
- ZIEL – Institute for Food & Health, Technische Universität München, München
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising
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11
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O’Brien ST, Neylon OM, O’Brien T. Dyslipidaemia in Type 1 Diabetes: Molecular Mechanisms and Therapeutic Opportunities. Biomedicines 2021; 9:biomedicines9070826. [PMID: 34356890 PMCID: PMC8301346 DOI: 10.3390/biomedicines9070826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in Type 1 Diabetes (T1D). The molecular basis for atherosclerosis in T1D is heavily influenced by hyperglycaemia and its atherogenic effects on LDL. Ongoing research into the distinct pathophysiology of atherosclerosis in T1D offers exciting opportunities for novel approaches to calculate CVD risk in patients with T1D and to manage this risk appropriately. Currently, despite the increased risk of CVD in the T1D population, there are few tools available for estimating the risk of CVD in younger patients. This poses significant challenges for clinicians in selecting which patients might benefit from lipid-lowering therapies over the long term. The current best practice guidance for the management of dyslipidaemia in T1D is generally based on evidence from patients with T2D and the opinion of experts in the field. In this review article, we explore the unique pathophysiology of atherosclerosis in T1D, with a specific focus on hyperglycaemia-induced damage and atherogenic LDL modifications. We also discuss the current clinical situation of managing these patients across paediatric and adult populations, focusing on the difficulties posed by a lack of strong evidence and various barriers to treatment.
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Affiliation(s)
- Stephen T. O’Brien
- Department of Paediatrics, University Hospital Limerick, V94 F858 Limerick, Ireland; (S.T.O.); (O.M.N.)
| | - Orla M. Neylon
- Department of Paediatrics, University Hospital Limerick, V94 F858 Limerick, Ireland; (S.T.O.); (O.M.N.)
| | - Timothy O’Brien
- Department of Medicine, School of Medicine, National University of Ireland, H91 TK33 Galway, Ireland
- Correspondence:
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Vitamin D and ω-3 Supplementations in Mediterranean Diet During the 1st Year of Overt Type 1 Diabetes: A Cohort Study. Nutrients 2019; 11:nu11092158. [PMID: 31505819 PMCID: PMC6770446 DOI: 10.3390/nu11092158] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/10/2019] [Accepted: 08/27/2019] [Indexed: 12/23/2022] Open
Abstract
Vitamin D and omega 3 fatty acid (ω-3) co-supplementation potentially improves type 1 diabetes (T1D) by attenuating autoimmunity and counteracting inflammation. This cohort study, preliminary to a randomized control trial (RCT), is aimed at evaluating, in a series of T1D children assuming Mediterranean diet and an intake of cholecalciferol of 1000U/day from T1D onset, if ω-3 co-supplementation preserves the residual endogen insulin secretion (REIS). Therefore, the cohort of 22 “new onsets” of 2017 received ω-3 (eicosapentenoic acid (EPA) plus docosahexaenoic acid (DHA), 60 mg/kg/day), and were compared retrospectively vs. the 37 “previous onsets” without ω-3 supplementation. Glicosilated hemoglobin (HbA1c%), the daily insulin demand (IU/Kg/day) and IDAA1c, a composite index (calculated as IU/Kg/day × 4 + HbA1c%), as surrogates of REIS, were evaluated at recruitment (T0) and 12 months later (T12). In the ω-3 supplemented group, dietary intakes were evaluated at T0 and T12. As an outcome, a decreased insulin demand (p < 0.01), particularly as pre-meal boluses (p < 0.01), and IDAA1c (p < 0.01), were found in the ω-3 supplemented group, while HbA1c% was not significantly different. Diet analysis in the ω-3 supplemented group, at T12 vs. T0, highlighted that the intake of arachidonic acid (AA) decreased (p < 0.01). At T0, the AA intake was inversely correlated with HbA1c% (p < 0.05; r;. 0.411). In conclusion, the results suggest that vitamin D plus ω-3 co-supplementation as well as AA reduction in the Mediterranean diet display benefits for T1D children at onset and deserve further investigation.
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Gourgari E, Dabelea D, Rother K. Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events? Curr Diab Rep 2017; 17:134. [PMID: 29101482 PMCID: PMC5670186 DOI: 10.1007/s11892-017-0968-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Patients with type 1 diabetes have increased risk for cardiovascular disease. The purpose of this review is to examine the following: i) current evidence for subclinical cardiovascular disease (CVD) in children with type 1 diabetes (T1DM) ii) known modifiable risk factors for CVD and their relationship to subclinical CVD in this population iii) studies that have addressed these risk factors in order to improve CVD outcomes in children with T1DM RECENT FINDINGS: Subclinical CVD presents in children as increased carotid intima-media thickness, increased arterial stiffness, and endothelial and myocardial dysfunction. Modifiable risk factors for CVD include hyperglycemia, hyperlipidemia, obesity, hypertension, depression, and autonomic dysfunction. Very few randomized controlled studies have been done in children with T1DM to examine how modification of these risk factors can affect their CVD. Children with T1DM have subclinical CVD and multiple modifiable risk factors for CVD. More research is needed to define how modification of these factors affects the progression of CVD.
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Affiliation(s)
- Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington DC, USA
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO USA
| | - Kristina Rother
- Section on Pediatric Diabetes and Metabolism, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD USA
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Steinke TJ, O'Callahan EL, York JL. Role of a registered dietitian in pediatric type 1 and type 2 diabetes. Transl Pediatr 2017; 6:365-372. [PMID: 29184817 PMCID: PMC5682368 DOI: 10.21037/tp.2017.09.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Type 1 and type 2 diabetes are complex, chronic diseases that are best managed by a multidisciplinary care team. Type 1 diabetes is most commonly diagnosed in the pediatric population, although the prevalence of type 2 diabetes in youth is increasing rapidly. A registered dietitian (RD) is a critical member of the diabetes team who provides focused nutrition education from diagnosis and throughout routine follow-up care. Specifically in the pediatric population, the RD also assesses growth and development, as well as eating behaviors, food choices and meal patterns. Based on a review of research, ongoing support from an RD improves glycemic control and delays onset of diabetes complications. In addition, dietitian-led nutrition education helps better manage lipid levels and aids in weight management. A sample model describing RD involvement in a pediatric diabetes care team is discussed in further detail.
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Affiliation(s)
- Tracie J Steinke
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elena L O'Callahan
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L York
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
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Zhong VW, Lamichhane AP, Crandell JL, Couch SC, Liese AD, The NS, Tzeel BA, Dabelea D, Lawrence JM, Marcovina SM, Kim G, Mayer-Davis EJ. Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study. Eur J Clin Nutr 2016; 70:802-7. [PMID: 26908421 PMCID: PMC4935596 DOI: 10.1038/ejcn.2016.8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/20/2015] [Accepted: 01/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I diabetes (TID). SUBJECTS/METHODS Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity. RESULTS In cross-sectional analyses using baseline data, for individuals with the hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl lower total cholesterol (TC) (P=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (P=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C) (P=0.004) and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dl lower TC (P=0.05), 1.6 mg/dl lower LDL-C (P=0.03) and 1.8 mg/dl lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity. CONCLUSIONS Mediterranean diet may improve glycemic control and cardiovascular health in TID youth.
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Affiliation(s)
- Victor W. Zhong
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jamie L. Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah C. Couch
- Department of Nutritional Sciences, University of Cincinnati, OH, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA
| | - Natalie S. The
- Department of Health Sciences, Furman University, SC, USA
| | - Benjamin A. Tzeel
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado, Denver, CO, USA
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Grace Kim
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Abstract
Managing severe insulin resistance (IR) in patients with type 1 diabetes (T1DM) can be challenging for both clinicians and patients. As average weight for patients with T1DM has increased in recent decades, IR in this population has become more widespread. Currently, almost 50 % of patients with T1DM are overweight or obese. While intensive insulin therapy is associated with reduction in complications, aggressive treatment can lead to weight gain. With increasing weight, insulin can become less effective to control glycemia, resulting in higher insulin doses and hence more weight gain. Novel strategies to break this vicious cycle are needed. This review will investigate current research on insulin formulations, lifestyle modification, adjunct therapies, and surgery that may help better manage patients with T1DM and IR.
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Nansel TR, Laffel LMB, Haynie DL, Mehta SN, Lipsky LM, Volkening LK, Butler DA, Higgins LA, Liu A. Improving dietary quality in youth with type 1 diabetes: randomized clinical trial of a family-based behavioral intervention. Int J Behav Nutr Phys Act 2015; 12:58. [PMID: 25952160 PMCID: PMC4436744 DOI: 10.1186/s12966-015-0214-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/20/2015] [Indexed: 01/29/2023] Open
Abstract
Background Diets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in foods of minimal nutritional value, increasing risk for future adverse health outcomes. This 18-month randomized clinical trial tested the effect of a family-based behavioral intervention integrating motivational interviewing, active learning, and applied problem-solving on the primary outcomes of dietary intake and glycemic control among youth with type 1 diabetes. Methods A parallel-group study with equal randomization was conducted at an outpatient, free-standing, multidisciplinary tertiary diabetes center in the United States. Eligible youth were those age 8–16 years with type 1 diabetes diagnosis ≥1 year and hemoglobin A1c (HbA1c) ≥6.5% and ≤10.0%. Participants were 136 parent-youth dyads (treatment n = 66, control n = 70). The intervention consisted of 9 in-clinic sessions delivered to the child and parent; control condition comprised equivalent assessments and number of contacts without dietary advice. Dietary intake was assessed using 3-day diet records at 6 time points across the 18-month study. Dietary outcomes included the Healthy Eating Index-2005 (HEI2005; index measuring conformance to the 2005 United States Dietary Guidelines for Americans) and Whole Plant Food Density (WPFD; number of cup or ounce equivalents per 1000 kcal of whole grains, whole fruit, vegetables, legumes, nuts, and seeds consumed). HbA1c was obtained every 3 months. Overall comparison of outcome variables between intervention and usual care groups was conducted using permutation tests. Results There was a positive intervention effect across the study duration for HEI2005 (p = .015) and WPFD (p = .004). At 18 months, HEI2005 was 7.2 greater (mean ± SE 64.6 ± 2.0 versus 57.4 ± 1.6), and WPFD was 0.5 greater (2.2 ± 0.1 versus 1.7 ± 0.1) in the intervention group versus control. There was no difference between groups in HbA1c across the study duration. Conclusions This behavioral nutrition intervention improved dietary quality among youth with type 1 diabetes, but did not impact glycemic control. Findings indicate the potential utility of incorporating such strategies into clinical care, and suggest that improvement in diet quality can be achieved in families living with this burdensome disease. Trial registration Clinicaltrials.gov registration number: NCT00999375 Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0214-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tonja R Nansel
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd. Rm 7B13R, MSC 7510, Bethesda, MD, USA.
| | - Lori M B Laffel
- Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Denise L Haynie
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd. Rm 7B13R, MSC 7510, Bethesda, MD, USA.
| | - Sanjeev N Mehta
- Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Leah M Lipsky
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd. Rm 7B13R, MSC 7510, Bethesda, MD, USA.
| | - Lisa K Volkening
- Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Deborah A Butler
- Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Laurie A Higgins
- Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Aiyi Liu
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd. Rm 7B13R, MSC 7510, Bethesda, MD, USA.
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Jaacks LM, Liu W, Ji L, Mendez MA, Du S, Crandell J, Rosamond W, Mayer-Davis EJ. Diabetes nutrition therapy and dietary intake among individuals with Type 1 diabetes in China. Diabet Med 2015; 32:399-406. [PMID: 25407093 PMCID: PMC4329062 DOI: 10.1111/dme.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 12/19/2022]
Abstract
AIMS To describe the contribution of diabetes nutrition therapy to disease self-management among individuals with Type 1 diabetes in China and to estimate the association of diabetes nutrition therapy with dietary intake. METHODS The 3C Study was an epidemiological study of the coverage, cost and care of Type 1 diabetes in China. The data reported in the present study are from the 3C Nutrition Ancillary Study, a follow-up study conducted a mean ± sd of 1.6 ± 0.2 years later. Diabetes nutrition therapy was assessed by an interviewer-administered questionnaire. Dietary intake was assessed using three 24-h recalls. The association of diabetes nutrition therapy with dietary intake was estimated using ancova. RESULTS Participants (n = 100; 54% male) had a mean ± sd age of 41.7 ± 16.3 years and a mean ± sd diabetes duration of 11.8 ± 9.7 years. Fewer than half of the participants reported that they had 'ever' met with a dietitian. While 64% of participants were taught carbohydrate counting, only 12% 'ever' use this tool. Participants on insulin pumps and those testing ≥ 1 time/day reported greater dietary flexibility and higher fruit intakes compared with participants on other insulin regimens and testing less frequently. After adjustment for confounding by age and occupation, there were no consistent differences in dietary intake across subgroups of diabetes nutrition therapy. CONCLUSIONS In this sample of individuals with Type 1 diabetes in China there is little dietitian involvement or carbohydrate counting. Increased frequency of nutrition education in conjunction with intensified self-monitoring of blood glucose is needed to improve care.
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Affiliation(s)
- L M Jaacks
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
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de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, Magge SN, Marx N, McGuire DK, Orchard TJ, Zinman B, Eckel RH. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care 2014; 37:2843-63. [PMID: 25114297 PMCID: PMC4170130 DOI: 10.2337/dc14-1720] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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