Dietary intake and hospitalisation due to diabetic ketoacidosis and hypoglycaemia in individuals with type 1 diabetes

Abstract

We investigated the association between diet and risk of hospitalisation for diabetic ketoacidosis (DKA) or hypoglycaemia in type 1 diabetes. Food records were used to assess dietary intake. Data on DKA and hypoglycaemia hospitalisations, within two years of dietary assessments, were obtained from registries. Analyses were conducted with and without macronutrient substitution. Data were available from 1391 participants, 28 (2.0%) and 55 (4.0%) of whom were hospitalised due to DKA or hypoglycaemia, respectively. In the adjusted model, self-reported alcohol intake was associated with increased (per 10 g: B = 1.463, 95% CI = 1.114–1.922, p = 0.006; per E%: B = 1.113, 95% CI = 1.027–1.206, p = 0.009), and fibre intake with reduced (per g/MJ: B = 0.934, 95% CI = 0.878–0.995, p = 0.034) risk of DKA hospitalisation. Substituting carbohydrates for fats was associated with increased risk for hypoglycaemia hospitalisation (B = 1.361, 95% CI = 1.031–1.795, p = 0.029), while substituting alcohol for carbohydrates (B = 1.644, 95% CI = 1.006–2.685, p = 0.047) or proteins (B = 2.278, 95% CI = 1.038–4.999, p = 0.040) increased the risk for DKA hospitalisation. In conclusion, refraining from alcohol intake is a preventable risk factor for DKA, while higher fibre intake seems rather protective. Increasing carbohydrate intake while decreasing that of fats, is associated with higher hypoglycaemia risk. Whether this is a cause or effect of hypoglycaemia remains to be established.

Exercise and nutrition in type 1 diabetes: Insights from the FinnDiane cohort

“…Our results suggest that increasing fiber intake and exchanging fats and carbohydrates with protein could lead to better glucose control in type 1 diabetes. Our results were in line with another study of diet composition in individuals hospitalized for ketoacidosis, where those with high fiber intake were less likely to be hospitalized for ketoacidosis ( 36 ). Interestingly, persons with a higher median percentage of energy intake, derived from carbohydrates were more likely hospitalized for severe hypoglycemia (45,5% vs. 43,6% in those with hospitalization for severe hypoglycemia vs. those without, respectively).…”

Association of Neighborhood Resources and Race and Ethnicity With Readmissions for Diabetic Ketoacidosis at US Children’s Hospitals

“…The COI includes measures such as reading and math proficiency, adult educational attainment, and access to healthy food, all of which are particularly important for children living with T1D because they must calculate insulin dosing, manage diabetes technology (eg, insulin pumps), and find healthy food choices. The importance is further supported by previous work showing that the risk of DKA and glycemic excursions are associated with lower parental educational level and unhealthy dietary intake choices . In addition, household food insecurity has been associated with higher hemoglobin A 1c values and hospitalization rates in children with T1D, which is notable because children with lower COI categories have more limited access to healthy food choices compared with those with higher COI categories .…”

“…The importance is further supported by previous work showing that the risk of DKA and glycemic excursions are associated with lower parental educational level 10 , 11 , 42 and unhealthy dietary intake choices. 43 , 44 , 45 , 46 In addition, household food insecurity has been associated with higher hemoglobin A 1c values and hospitalization rates in children with T1D, 47 which is notable because children with lower COI categories have more limited access to healthy food choices compared with those with higher COI categories. 13 , 48 , 49 Less frequent use of diabetes technology, particularly continuous glucose monitoring devices, has also been associated with worse health outcomes in children with T1D, including higher rates of DKA 50 and time spent in hyperglycemia.…”

Effects of the timing of the initiation of dietary intake on pediatric type 1 diabetes for diabetic ketoacidosis

“…For example, one study involving adolescents with T1D suggested that eating disorders have more than triple the risk of DKA [ 16 ]. Another study investigated the association between different diet composition and risk of DKA in T1D [ 17 ]. Due to leptin’s acute insulin-independent effect to reverse DKA [ 18 ], and increased leptin secretion by food intake [ 19 – 21 ], we hypothesize that leptin may mediate the relationship between the timing of the initiation of dietary intake and DKA correction as an internal mechanism.…”