Victor W Zhong1, Jamie L Crandell2, Christina M Shay3, Penny Gordon-Larsen4, Stephen R Cole5, Juhaeri Juhaeri6, Anna R Kahkoska1, David M Maahs7, Michael Seid8, Gregory P Forlenza9, Elizabeth J Mayer-Davis10. 1. Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA. 2. School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA. 3. Center for Health Metrics and Evaluation, the American Heart Association, Dallas, TX, USA. 4. Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. 5. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. 6. Global Pharmacovigilance and Epidemiology, Sanofi, Bridgewater, NJ, USA. 7. Lucile Packard Children's Hospital and Stanford University Medical Center, Stanford University, Palo Alto, CA, USA. 8. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 9. Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA. 10. Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address: mayerdav@email.unc.edu.
Abstract
AIMS: To determine the association between dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes. METHODS: Type 1 adolescents from a randomized trial wore a blinded continuous glucose monitoring (CGM) system at baseline for one week in free-living conditions. Dietary intake was calculated as the average from two 24-h dietary recalls. Non-severe hypoglycemia was defined as having blood glucose <70mg/dL for ≥10min but not requiring external assistance, categorized as daytime and nocturnal (11PM-7AM). Data were analyzed using logistic regression models. RESULTS: Among 98 participants with 14,277h of CGM data, 70 had daytime hypoglycemia, 66 had nocturnal hypoglycemia, 55 had both, and 17 had neither. Soluble fiber and protein intake were positively associated with both daytime and nocturnal hypoglycemia. Glycemic index, monounsaturated fat, and polyunsaturated fat were negatively associated with daytime hypoglycemia only. Adjusting for total daily insulin dose per kilogram eliminated all associations. CONCLUSIONS:Dietary intake was differentially associated with daytime and nocturnal hypoglycemia. Over 80% of type 1 adolescents had hypoglycemia in a week, which may be attributed to the mismatch between optimal insulin dose needed for each meal and actually delivered insulin dose without considering quality of carbohydrate and nutrients beyond carbohydrate. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01286350.
RCT Entities:
AIMS: To determine the association between dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes. METHODS: Type 1 adolescents from a randomized trial wore a blinded continuous glucose monitoring (CGM) system at baseline for one week in free-living conditions. Dietary intake was calculated as the average from two 24-h dietary recalls. Non-severe hypoglycemia was defined as having blood glucose <70mg/dL for ≥10min but not requiring external assistance, categorized as daytime and nocturnal (11PM-7AM). Data were analyzed using logistic regression models. RESULTS: Among 98 participants with 14,277h of CGM data, 70 had daytime hypoglycemia, 66 had nocturnal hypoglycemia, 55 had both, and 17 had neither. Soluble fiber and protein intake were positively associated with both daytime and nocturnal hypoglycemia. Glycemic index, monounsaturated fat, and polyunsaturated fat were negatively associated with daytime hypoglycemia only. Adjusting for total daily insulin dose per kilogram eliminated all associations. CONCLUSIONS: Dietary intake was differentially associated with daytime and nocturnal hypoglycemia. Over 80% of type 1 adolescents had hypoglycemia in a week, which may be attributed to the mismatch between optimal insulin dose needed for each meal and actually delivered insulin dose without considering quality of carbohydrate and nutrients beyond carbohydrate. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01286350.
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