Dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes

J Diabetes Complications. 2017 Aug;31(8):1340-1347. doi: 10.1016/j.jdiacomp.2017.04.017. Epub 2017 Apr 20.

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.

Keywords: Continuous glucose monitoring; Dietary intake; Hypoglycemia; Nutrition; Type 1 diabetes.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Adolescent
  • Adolescent Nutritional Physiological Phenomena*
  • Blood Glucose / analysis
  • Colorado / epidemiology
  • Combined Modality Therapy / adverse effects
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diet therapy*
  • Diet, Diabetic*
  • Exercise
  • Female
  • Humans
  • Hyperglycemia / prevention & control
  • Hypoglycemia / epidemiology
  • Hypoglycemia / etiology
  • Hypoglycemia / physiopathology
  • Hypoglycemia / prevention & control*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Insulin / administration & dosage
  • Insulin / adverse effects
  • Insulin / therapeutic use
  • Male
  • Monitoring, Ambulatory
  • Ohio / epidemiology
  • Patient Compliance*
  • Risk
  • Severity of Illness Index
  • Single-Blind Method

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin

Associated data

  • ClinicalTrials.gov/NCT01286350