Associations of nutrient intake with glycemic control in youth with type 1 diabetes: differences by insulin regimen

Diabetes Technol Ther. 2014 Aug;16(8):512-8. doi: 10.1089/dia.2013.0389. Epub 2014 Apr 25.


Background: Type 1 diabetes management has evolved from meal plans towards flexible eating with carbohydrate counting. With this shift, youth with type 1 diabetes may consume excess fat and insufficient fiber, which may impact glycemic control. Few studies consider whether insulin regimen influences associations between dietary intake and hemoglobin A1c.

Patients and methods: In this cross-sectional study, 252 youth (52% male; age, 13.2 ± 2.8 years; body mass index z-score [z-BMI], 0.7 ± 0.8) with type 1 diabetes completed 3-day food records. Dietary intake was compared with published guidelines. Logistic regression predicted the odds of suboptimal glycemic control (an A1c level of ≥ 8.5%) related to fat and protein intake or fiber intake according to insulin regimen (pump vs. injection) adjusting for age, sex, diabetes duration, z-BMI, insulin dose, glucose monitoring frequency, and total energy intake (TEI).

Results: Youth had a mean TEI of 40.9 ± 15.4 kcal/kg/day and excess fat and insufficient fiber intake compared against published guidelines. Pump-treated youth consuming the highest quartile of fat intake (as percentage TEI) had 3.6 (95% confidence interval, 1.3-9.7) times the odds of a suboptimal A1c than those in the lowest quartile. No such association was found in injection-treated youth. In the total sample, youth with the lowest quartile of fiber intake had 3.6 (95% confidence interval, 1.4-9.0) times the odds of a suboptimal A1c, but this association did not differ by insulin regimen. There was no association between protein intake and A1c.

Conclusions: Higher fat intake in pump-treated youth and lower fiber intake in all youth were associated with an A1c level of ≥ 8.5%. Improving dietary quality may help improve A1c.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior* / psychology
  • Attitude to Health
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring
  • Body Mass Index
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diet therapy*
  • Diabetes Mellitus, Type 1 / psychology
  • Diet / adverse effects*
  • Diet / psychology
  • Diet Records
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / administration & dosage
  • Dietary Fiber / administration & dosage
  • Feeding Behavior* / psychology
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Male
  • Patient Education as Topic


  • Blood Glucose
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Fiber
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human