Emphasis on Carbohydrates May Negatively Influence Dietary Patterns in Youth With Type 1 Diabetes

Abstract

OBJECTIVETo assess perceptions of healthful eating and the influence of diabetes management on dietary behaviors among youth with type 1 diabetes and parents.RESEARCH DESIGN AND METHODSYouth with type 1 diabetes (n = 35), ages 8–21 years, and parents participated in focus groups. Focus group recordings were transcribed and coded into themes. Clinical data were abstracted from the electronic medical record.RESULTSCentral topics were perceptions of healthful eating and the impact of diabetes management on diet. An emphasis on limiting postprandial glycemic excursions occasionally contradicted the traditional perception of healthful eating, which emphasized consumption of nutrient-dense whole foods in favor of prepackaged choices. Whereas fixed regimens required more rigid diets, basal-bolus regimens provided more opportunities for unhealthful eating. Most youth perceived “refined” grains as more healthful grains.CONCLUSIONSFor youth with type 1 diabetes and parents, an emphasis on carbohydrate quantity over quality may distort beliefs and behaviors regarding healthful eating.

Relationships of neophobia and pickiness with dietary variety, dietary quality and diabetes management adherence in youth with type 1 diabetes

“…1 Although dietary intake is an integral part of diabetes management, 35 previous research suggests that families of youth with T1D may not prioritize healthful eating, given the multiple demands of diabetes management, as well as barriers to healthy eating such as the widespread availability of unhealthy foods, lack of food preparation time and desire for intakes consistent with friends given the already substantial differences placed upon the youth with diabetes compared with their peer group. 19,36 In addition, some families may focus on a food’s postprandial glycemic response, emphasizing both the amount of carbohydrate and ease of carbohydrate estimation, which may limit the foods children with T1D choose to eat. 36 …”

“…19,36 In addition, some families may focus on a food’s postprandial glycemic response, emphasizing both the amount of carbohydrate and ease of carbohydrate estimation, which may limit the foods children with T1D choose to eat. 36 …”

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

“…330 However, reduction of carbohydrate may contribute to increased fat intake as diabetes mellitus management (to improve glucose control) and may have negative effects on cardiovascular health. 331,332 Youth with T1DM have documented higher fat intakes that are positively associated with HbA 1c levels. 333 Disturbed eating behaviors are common among youth with T1DM.…”

The relationship between carbohydrate and the mealtime insulin dose in type 1 diabetes

“…It has been postulated that an increased focus on carbohydrate counting can lead to an increased intake of packaged food as the nutrition label facilitates carbohydrate counting. There is evidence to suggest that people with type 1 diabetes consume excess protein and fat and are at increased risk of cardiovascular disease (Mehta, Haynie, Higgins, & Laffel, 2009;Overby, King, et al, 2006). It is therefore imperative that healthy eating remains central in diabetes education, with an emphasis on selecting foods for their nutritional value rather than based on their ease of carbohydrate quantification.…”

“…Some participants reported that their fat consumption increased as carbohydrate free, high fat meals were perceived as the easy option . Given that people with type 1 diabetes reportedly have higher total fat and saturated fat intakes than healthy people (Overby et al, 2006;Helgeson, Viccaro, Becker, Escobar, & Siminerio, 2006) and their fruit, vegetable and fiber intakes fall below recommendations (Pietilainen, Virtanen, Rissanen, Rita, & Maenpaa, 1995;Nansel et al, 2012), care is needed when teaching carbohydrate counting that an emphasis on carbohydrate does not detract from healthy eating principles (Mehta, Haynie, et al, 2009).…”