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Nutrition education using a food-based approach, carbohydrate counting, or routine care in type 1 diabetes

Background

People with type 1 diabetes (T1D), a chronic autoimmune disease that destroys the insulin-producing cells in the pancreas, are at an increased risk for cardiovascular disease (CVD). Although nutrition is a cornerstone in the prevention of T1D complications, clinical research that compares the effects of different types of nutrition education programs on glycemic control, CVD risk factors, and other relevant outcomes in people with T1D is lacking.

The study

In this 12-month randomized controlled trial, 135 T1D patients (ages 20–70) with moderately impaired glycemic control followed one of three nutrition education programs:

  • The food-based approach (FBA) group program progressively incorporated food groups into the diet. The foods were fish, mixed nuts and seeds, vegetables, legumes, fruit and berries, and whole grains with low glycemic index.

  • The carbohydrate counting (CC) group program calculated how much insulin to dose with each meal.

  • The routine care (RC) individual program delivered counseling sessions with an open agenda and without structured educational materials.

The primary outcome was glycated hemoglobin (HbA1c) at 12 months. The secondary outcomes were cardiovascular risk factors, quality of life, diet quality, and food choices.

The results

After 3 months, HbA1c improved more with FBA and CC than with RC. However, at 12 months, this difference was absent.

At 12 months, the FBA group participants reported a higher intake of legumes, nuts, and vegetables, compared to the CC and RC groups. The FBA group participants also reported a higher intake of mono- and polyunsaturated fats, as compared with RC, and a higher intake of dietary fiber and mono- and polyunsaturated fats, as compared with CC.

Note

The results suggest that although an FBA may have beneficial effects on food choices and nutrient quality, the FBA, CC, and RC approaches produce similar results in terms of HbA1c after 12 months in T1D patients with moderately impaired glycemic control.

Tags: #Dietitians

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