Glycemic Control In Youth Research Articles

Dietary Fiber and Bone Density in Youth with Type 2 Diabetes

Abstract Objectives Assess relationships between dietary fiber and bone density in youth with type 2 diabetes, obesity, and healthy weight. Methods Cross-sectional study of youth (56% African American, 67% female) ages 10–23 years with type 2 diabetes (n = 180), obesity (BMI >95th; n = 226), or healthy weight (BMI < 85th; n = 238). Total body bone mineral density (BMD) was assessed via DXA. BMD standard deviation scores (“Z-scores”) were computed using published reference data. Dietary fiber (total, soluble, and insoluble) and total calories were assessed via 3-day food diaries, which were analyzed using the Nutrition Data System for Research. Relationships between dietary fiber and BMD Z-score were assessed using linear regression. Separate analyses were performed for total, soluble, and insoluble fiber, and each regression model included age, sex, ancestry, total calories, group, and fiber (total, soluble, or insoluble), as well as group by fiber interactions. Results BMD Z-score was greater in the type 2 diabetes and obese compared to the healthy weight group (P < 0.001). Total, soluble, and insoluble fiber intakes were significantly greater in the healthy weight versus obese group (all P < 0.05), but only marginally greater than the type 2 diabetes group (all P = 0.06–0.10). Regression analyses demonstrated positive relationships between total, soluble, and insoluble fiber intakes and BMD Z-score (all P < 0.05). However, significant group by fiber interactions indicated that the positive relationships between dietary fiber intakes and BMD Z-score was evident only in the healthy weight group (all P < 0.005). Similar relationships were observed when considering BMD Z-score adjusted for height Z-score. Conclusions Prior studies have reported a favorable influence of dietary fiber on bone mineral accrual in healthy individuals and metabolic health in adults with insulin resistance. Dietary strategies promoting increased fiber consumption warrant investigation with respect to fracture prevention and glycemic control in youth with type 2 diabetes. Funding Sources NIH-NHLBI, American Diabetes Association, and Endocrine Fellows Foundation.

Partial Hospitalization: An Intervention for Youth with Poorly Controlled Diabetes Mellitus

Objective: To examine the efficacy of an integrated medical/psychiatric partial hospitalization program (PHP) to improve glycemic control in youth with both diabetes mellitus and mental health disorders. Methods: This retrospective chart review is of patients admitted to a PHP between 2005-2015 with concerns about diabetes mellitus care. Clinical characteristics, laboratory data, diabetic ketoacidosis hospitalizations, and outpatient clinic visit frequency were collected from the year prior to the year after PHP admission. Results: A total of 43 individuals met inclusion criteria: 22 (51%) were female, 40 (93%) had type 1 diabetes, the mean age was 15.2 ± 2.3 years, and the mean diabetes mellitus duration was 4.6 ± 3.6 years. Of those individuals, 35 of these patients had hemoglobin A1c (HbA1c) data available at baseline, 6 months, and 1 year after PHP. The average HbA1c before PHP admission was 11.3 ± 2.3% (100.5 ± 25 mmol/mol), and decreased to 9.2 ± 1.3% (76.7 ± 14.8 mmol/mol) within 6 months of PHP admission (P<.001). The average HbA1c 1 year after PHP was 10.7 ± 1.7 % (93.3 ± 19.1 mmol/mol). Overall, 24 patients (68%) had lower HbA1c, and 75% of those with improvement maintained an HbA1c reduction of ≥1% (≥10 mmol/mol) at 1 year compared to before PHP. Conclusion: Most patients demonstrated improved glycemic control within 6 months of PHP admission, and many of those maintained a ≥1% (≥10 mmol/mol) reduction in HbA1c at 1 year following PHP admission. This program may represent a promising intervention that could serve as a model for intensive outpatient management of youth with poorly controlled diabetes mellitus. Abbreviations: ADA = American Diabetes Association; DKA = diabetic ketoacidosis; EMR = electronic medical record; HbA1c = hemoglobin A1c; ICD-9 = International Classification of Diseases, 9th revision; PHP = partial hospitalization program.

The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes.

To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. This study was conducted using a survey with a convenience sample following the STROBE guidelines. A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.

Impact of Switching Youth With Diabetes to Insulin Degludec in Clinical Practice

Many youth with diabetes struggle to meet glycemic targets. The new ultralong duration of action of insulin degludec (iDeg) holds potential to ameliorate missed doses of basal insulin and improve glycemic control in youth with diabetes. A retrospective chart review was undertaken of youth age 13 to <24 years in our practice with type 1 diabetes (T1D) or type 2 diabetes (T2D) who had been switched from glargine or detemir to iDeg to evaluate the impact of this transition on glycemic control. Glycated hemoglobin A1c (HbA1c) in youth with T1D (n = 82) remained stable during 6 months of treatment with iDeg (10.1 ± 2.11% [87 ± 23 mmol/mol] at start of iDeg compared to 10.1 ± 2.12% [87 ± 23 mmol/mol] at 6 months of treatment), whereas in youth with T2D (n = 16), HbA1c significantly declined from 10.6 ± 2.3% (92 ± 25 mmol/mol) to 8.3 ± 2.2% (67 ± 24 mmol/mol) ( P = .0024). In youth switched to iDeg, which in our practice is commonly due to ineffectiveness of the patient's current regimen, the outcome differences we saw may be due to preserved beta-cell function in youth with T2D. It remains to be seen whether there are benefits of transition to iDeg in youth with T1D beyond glycemic outcomes, such as reduction in ketosis and episodes of diabetic ketoacidosis. DKA = diabetic ketoacidosis; DPV = Diabetes-Patienten-Verlaufsdokumentation (German/Austrian Prospective Diabetes Follow-Up Registry); HbA1c = glycated hemoglobin A1c; iDeg = insulin degludec; T1D = type 1 diabetes; T2D = type 2 diabetes.

Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina.

Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA1c (P = 0.048) compared to having specialist care, but HbA1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.

Diabetes management mediates the association between sleep duration and glycemic control in youth with type 1 diabetes mellitus

Objective/backgroundThe purpose of this study was to examine the associations of diabetes management and sleep duration with glycemic control in youth with type 1 diabetes mellitus. Patients/methods111 participants (mean age = 13.59 ± 2.11 years, 52.3% male, 50.5% non-white) wore actigraphy (average duration = 5.5 nights) and completed self-reported daily sleep diaries (average duration = 5.3 nights). Parents and participants each completed the Diabetes Management Scale (DMS) as part of a neurobehavioral evaluation. Glycated hemoglobin (HbA1c) and daily frequency of self-monitored blood glucose (SMBG) were collected from patient medical records. ResultsYouth with T1DM slept below the recommended amount of sleep for this age group (M = 7.45, SD = 0.74), which is approximately 9 h for school aged youth. They were in poor glycemic control with an average HbA1c of 9.11% (SD = 1.95) and their SMBG frequency was 4.9 (SD = 2.71). Average sleep duration from actigraphy was significantly correlated with average SMBG frequency and inversely related to HbA1c, indicating that less sleep was associated with worse management and glycemic control. When entered into a mediation model, diabetes management (SMBG frequency) completely mediated the relationship between sleep duration and glycemic control (HbA1c). Different sleep parameters of sleep quality, time to sleep, and sleep consistency also significantly correlated with HbA1c, SMBG, and parent and child-reports of various aspects of diabetes management. In particular, later bedtimes and a greater social jetlag predicted worse glycemic control. ConclusionsIn a sample of sleep deprived and poorly controlled youth with T1DM, diabetes management was an intermediary factor between sleep duration and glycemic control. Additional analyses of data supported circadian influences on glycemic control. These results highlight the importance of addressing sleep duration, quality, and consistency as part of routine diabetes management in this population.

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Diabetes Device Use and Glycemic Control among Youth with Type 1 Diabetes: A Single-Center, Cross-Sectional Study

Aim The purpose of this cross-sectional study was to determine the rates of diabetes device use (insulin pump and continuous glucose monitor (CGM)) and association with glycemic control in youth with type 1 diabetes in a large, diverse pediatric center. Methods Demographic and clinical data were obtained from 1992 patients who met the eligibility criteria (age < 26 years, diabetes duration ≥ 1 year, and ≥1 clinic visit in the preceding 12 months). Statistical analyses assessed the likelihood of device use based on demographic characteristics and the association between device use and glycemic control based on most recent hemoglobin A1c (HbA1c). Results Mean age was 13.8 ± 4.2 years, 50.7% were female, diabetes duration was 6.2 ± 4 years, and mean HbA1c was 8.7 ± 1.8%. Overall, 38.2% of patients were on pump therapy and 18.5% were on CGM. Patients who were non-Hispanic (NH) white, privately insured, and with primary English-speaking parent(s) had higher rates of insulin pump use, as well as CGM use (P < 0.001 for both). Female patients had higher rates of pump use only (P < 0.01). Private health insurance, NH white race/ethnicity, and CGM use were each associated with lower HbA1c (P = 0.03, <0.001, and <0.008, resp.). Conclusion At a large, diverse, pediatric diabetes center, disparities in diabetes device use were present across sex, race/ethnicity, health insurance coverage, and primary language of parent(s). CGM use was associated with lower HbA1c. Quality improvement efforts are underway to ensure improved access, education, and clinical programs for advanced diabetes devices for T1D patients.

Health Care Access, Utilization, and Glycemic Control in Youth and Young Adults with Diabetes in South Carolina

Affordability and spatial accessibility are key dimensions of access to health care and important determinants of health. In populations with diabetes, evidence is largely limited to those with type 2 diabetes and older adults. We evaluated the association of insurance coverage and diabetes care provider characteristics with glycemic control in youth and young adults (YYA) with diabetes aged 6 to 30 years (median 16 years), participating in the SEARCH for Diabetes in Youth study in South Carolina between January 2012 and July 2015. A total of 540 YYAs with diabetes (437 type 1, 103 type 2) provided information on health insurance type, diabetes care provider (type and address); HbA1c was measured in-person. Geographic information systems were used to calculate distance to the reported provider. Multivariate linear regression analyses were utilized to evaluate the association. More than half of YYAs with diabetes utilized state/federal insurance (46%) or were uninsured (18%). Only 79% indicated a diabetes care provider. The majority (62%) were seeing an endocrinologist, traveling 27 miles on average (median 16 miles). Average HbA1c was 9.2%. Compared to those with private insurance, YYAs with state/federal health insurance had 0.78 higher HbA1c levels (p&amp;lt;.001) and those with no insurance had 1.1 higher HbA1c (p&amp;lt;.0001), independent of age, sex, race/ethnicity, urbanicity, diabetes type, duration, and medication regimen. Compared to receiving care by an endocrinologist, reporting care by a primary care provider was associated with a 0.6 higher HbA1c (p=.028) and a 0.8 higher level (p=.007) with no routine diabetes care provider reported. Distance to provider was not associated with glycemic control (p=.18). In summary, health insurance status and type, and provider type were significantly associated with glycemic control. This study underscores the importance of social determinants of health on diabetes management outcomes in youth and young adults. Disclosure A.D. Liese: None. X. Ma: None. L. Reid: None. J.M. Eberth: None. B.A. Bell: None. J. Probst: None. C.B. Turley: Stock/Shareholder; Self; AbbVie Inc., Johnson &amp; Johnson Services, Inc., Pfizer Inc., CVS/Caremark, Amgen Inc., Walgreen Co., UnitedHealth Group, Novartis AG, Abbott. E.J. Mayer-Davis: None.

Socioeconomic Profiles as Predictors of Glycemic Control in Youth with Type 1 Diabetes

Various measures of socioeconomic status (SES) predict glycemic control in youth and young adults (YYA) with type 1 diabetes; however, rarely have multiple SES factors been considered simultaneously, including parental education and income, food security, health insurance status, and food assistance. The purpose of this study was to identify multidimensional SES profiles in YYA with type 1 diabetes and to assess the association between these profiles and glycemic control. Data from 257 YYA with type 1 diabetes enrolled in the SEARCH Food Insecurity Ancillary Study in South Carolina and Washington between the years 2013 and 2015 were included. We identified SES profiles utilizing latent class analysis and used multivariable logistic regression to compare the profiles’ glycemic control, with HbA1c &amp;gt; 9% defined as poor glycemic control. Two profiles were identified: Profile 1 (74%) included YYA that were of higher parental income and education, and less likely to have government-funded health insurance, to receive food assistance, and to be food insecure. Profile 2 (26%) included YYA who were categorized opposite to that of profile 1. In profile 2, 60% of YYA had poor glycemic control compared to 44% of YYA in profile 1. After adjustment for age, sex, race/ethnicity, site, diabetes duration, and diabetes medication, YYA in profile 2 were significantly more likely to have poor glycemic control relative to YYA in profile 1 (OR = 1.94, 95% CI = 1.01-3.71). Membership to a lower SES profile is associated with poor glycemic control among YYA with T1D. Strategies to improve glycemic control, particularly in YYA who belong to lower SES profiles, are needed. Disclosure M.W. Sutherland: None. X. Ma: None. J.A. Mendoza: None. B.A. Bell: None. B.A. Reboussin: None. A.R. Kahkoska: None. K.A. Sauder: None. C. Pihoker: None. A.D. Liese: None.

Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Glycemic control (GC) is difficult to achieve in settings where only NPH, R and pre-mixed insulins are available, test strips are scarce, and food insecurity is common. We evaluated the impact of a sliding-scale based insulin adjustment protocol in Haiti. Thirty youth aged 11-28 years with T1D treated with 70/30 Mixtard were randomized to remain on 70/30 (G70, n=15) or switch to self-mixed NPH+R (GNR, n=15). Carbohydrate (CHO) ratio and insulin sensitivity factor were calculated based on total daily insulin dose (TDD), and translated into sliding scales with either insulin correction dose (ICD) only (G70), or the sum of a 60 g CHO meal dose and ICD (GNR). Self-monitored blood glucose (SMBG) and insulin were administered before AM and PM meals. All had bi-monthly visits for 12 weeks. In G70 vs. GNR, age (19.3±4.5 vs. 19.2±5.4 years), sex (40 vs. 53% m), normal BMI (87 vs. 80%), diabetes duration (5.3±4.2 vs. 5.3±4.5 years), and baseline A1c (9.8±2.1 vs. 10.8±2.9%, p=0.27) did not differ. A1c declined to 8.0±1.3% (-1.8%, p&amp;lt;0.006) vs. 8.9±1.2% (-1.9%, p&amp;lt;0.02), p=0.83, without severe acute complication. Skipped meals per week (3.7±2.9 vs. 4.1±3.3), missed SMBG (3.5±3.4 vs. 7.4±7.6%, p=0.07), and increase of TDD (7.7±7.8 vs. 6.6±9.6 units) were similar. Use of sliding scales adjusted for SMBG and meals omission, and frequent clinic visits significantly improved GC in youth with T1D in a low-resource setting, regardless of pre- or self-mixed insulin. Disclosure E. Jean Baptiste: None. P. Larco: None. M. Charles Larco: None. J.E. von Oettingen: None. E. Dubois: None. R. Paul: None. E. Fleury-Milfort: None. R. Charles: None. G.D. Ogle: None.

Hope and mealtime insulin boluses are associated with depressive symptoms and glycemic control in youth with type 1 diabetes mellitus.

Adherence to treatment regimen is associated with improved glycemic control and is particularly problematic during adolescence for those with type 1 diabetes mellitus (T1DM). Both glycemic control and adherence may be negatively impacted by poor psychological outcomes in adolescence, such as depressive symptoms and low hopefulness. The purpose of this study was to examine associations between the mealtime insulin bolus score (BOLUS), a more robust proxy measure of adherence than frequency of blood glucose monitoring or self-report, with depressive symptoms, hope, and hemoglobin A1c (HbA1c). Ninety adolescents completed measures of hope (Children's Hope Scale) and depressive symptoms (Center for Epidemiologic Studies-Depression Scale), as well as lab-based measures of HbA1c and mealtime insulin bolus scores (BOLUS). Higher levels of hope were associated with lower levels of depressive symptoms, more frequent mealtime insulin boluses, and better glycemic control. Higher levels of BOLUS behavior were associated with lower depressive symptoms and better glycemic control. Both BOLUS behavior and hope independently and significantly impacted the relationship between depressive symptoms and HbA1c, suggesting a possible mediation. Since hope and BOLUS were each associated with the relationship between depressive symptoms and glycemic control, following confirmation of this relationship in a longitudinal study, clinics may consider measuring hope and BOLUS among youth with high depressive symptoms and further investigating BOLUS behavior and hope as potential intervention targets to improve glycemic control.

Baseline Psychosocial Characteristics Predict Frequency of Continuous Glucose Monitoring in Youth with Type 1 Diabetes.

Consistent use of continuous glucose monitoring (CGM) has been associated with improved glycemic control in youth with type 1 diabetes (T1D). There are many barriers to device uptake and continued use. There is a need to understand patient-specific characteristics when considering CGM. We evaluated patterns of CGM use and associations between baseline psychosocial measures and frequency of CGM use over 1 year. Youth with T1D (n = 120), ages 8-18 years, completed questionnaires at CGM initiation and after 6 and 12 months assessing depressive symptoms, diabetes burden, and diabetes-specific and generic quality of life (QOL). Youth (51% male and 95% white) had mean age 12.7 ± 2.7 years, diabetes duration 6.1 ± 3.6 years, and glycated hemoglobin (HbA1c) 8.0 ± 0.8%. Over 1 year, 35% of youth used CGM 6 to 7 days per week, 45% used CGM 3-5 days per week, and 20% used CGM only 0-2 days per week. Youth who used CGM 3-7 days per week over 12 months had lower HbA1c at months 9 and 12 than youth who used CGM 0-2 days per week (9 months: 7.9 ± 0.9% vs. 8.5 ± 1.1%, P = 0.006 and 12 months: 8.0 ± 0.9% vs. 8.5 ± 1.1%, P = 0.02). Those using CGM 0-2 days per week had greater endorsement of depressive symptoms and diabetes burden and reported lower QOL at baseline compared with those using CGM 3-7 days per week. CGM use for 3 or more days per week over 12 months had a protective effect on HbA1c. Providers should consider addressing psychosocial parameters when initiating CGM to maximize uptake and promote continued use in youth with T1D.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

Depressive symptoms and glycemic control in youth with type 2 diabetes participating in the TODAY clinical trial

The relationship between depressive symptoms and glycemic control in youth with type 2 diabetes was assessed at baseline (n = 682), 6, and/or 24 months (n = 576). Neither baseline nor persistence of depressive symptoms was significantly associated with maintenance of glycemic control. Nevertheless, depressive symptoms were common, suggesting the importance of repeated screening.

High-intensity interval exercise and glycemic control in adolescents with type one diabetes mellitus: a case study

Current physical activity guidelines for youth with type 1 diabetes (T1D) are poorly supported by empirical evidence and the optimal dose of physical activity to improve glycemic control is unknown. This case report documents the effect of acute high‐intensity interval exercise (HIIE) and moderate‐intensity exercise (MIE) on 24‐h glycemic control in three adolescents with T1D using continuous glucose monitoring. Results highlight varied individual response to exercise across the participants. In two participants both MIE and HIIE resulted in a drop in blood glucose during exercise (−38 to −42% for MIE and −21–46% in HIIE) and in one participant both MIE and HIIE resulted in increased blood glucose (+19% and + 36%, respectively). Over the 24‐h period average blood glucose was lower for all participants in the HIIE condition, and for two for the MIE condition, compared to no exercise. All three participants reported HIIE to be more enjoyable than MIE. These data show both HIIE and MIE have the potential to improve short‐term glycemic control in youth with T1D but HIIE was more enjoyable. Future work with a larger sample size is required to explore the potential for HIIE to improve health markers in youth with T1D.

Biopsychosocial pathways linking subjective socioeconomic disadvantage to glycemic control in youths with type I diabetes

Older adolescent and young adults (OAYA) with type 1 diabetes (T1D) living in contexts of socio-economic disadvantage (SED) suffer disproportionately from poor glycemic control and related health complications. Although SED may convey a variety of risks, it may exacerbate diabetes-related stress levels, which in turn may account for observed disparities in health outcomes. The primary goal of the present study was to investigate the relationship between subjective SED, diabetes-related perceived stress, and diurnal cortisol secretion in urban OAYA with T1D. A secondary goal was to determine if cortisol was related to measures of blood glucose (HbA1c and mean blood glucose). Analyses were conducted among OAYA ages 17–20 years (n=61) affected by T1D, who provided daily saliva samples for four days, measures of glycemic control (i.e., HbA1c and mean blood glucose assessed via Continuous Glucose Monitor), and completed psychosocial questionnaires. We found that subjective SED was associated with a flatter diurnal cortisol rhythm via diabetes-related stress. Flattened cortisol rhythm was, in turn, associated with higher levels of HbA1c, but not with mean blood glucose assessed via Continuous Glucose Monitor. These results represent some of the first empirical evidence on how distal social factors (i.e., subjective SED) and proximal psychological processes (diabetes-related perceived stress) are connected to condition-relevant biological mechanisms (i.e., elevated HbA1c), via broad biological pathways implicated in health (i.e., flatter cortisol slope).

Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study.

Objective To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth's problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods Parents of youth 8–15 yrs (at baseline) (N = 174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth's HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results Low well-being was reported by 32% of parents. No relationship was found between parents' WHO-5 scores and youth's HbA1c (β = −0.052, p = 0.650). WHO-5 related to SDQ (β = −0.219, p < 0.01), DFBC unsupportive scale (β = −0.174, p < 0.01), and PAID-Pr (β = −0.666, p < 0.01). Both DFBC scales (supportive β = −0.259, p = 0.01; unsupportive β = 0.383, p = 0.017), PAID-Pr (β = 0.276, p < 0.01), and SDQ (β = 0.424, p < 0.01) related to HbA1c. Conclusions Over time, reduced parental well-being relates to increased problem behavior in youth, unsupportive parenting, and parental distress, which negatively associate with HbA1c. More unsupportive diabetes parenting and distress relate to youth's problem behavior.

Quality of Life in Type 1 Diabetes and Celiac Disease: Role of the Gluten-Free Diet

To evaluate quality of life (QoL) and glycemic control in youth with type 1 diabetes (T1D) and celiac disease vs T1D only. We hypothesized that QoL scores would be lower in youth with T1D and celiac disease and those nonadherent to the gluten-free diet (GFD). This case control study included 35 youth with T1D and 35 with T1D and celiac disease matched for age, sex, diabetes duration, and hemoglobin A1c level. QoL was assessed in participants and parents using the Pediatric Quality of Life Inventory Generic Core Scale, Pediatric Quality of Life Inventory Diabetes Module. and the General Well-Being Scale; youth with T1D and celiac disease also completed the celiac disease-specific DUX questionnaire and parents completed the Pediatric Quality of Life Inventory Family Impact Scale. Questionnaires were scored from 0 to 100; higher scores indicate better QoL or well-being. Scores were compared between T1D vs T1D with celiac disease, with subgroup analysis by GFD adherence vs nonadherence and therapy (continuous subcutaneous insulin infusion vs multiple daily injections). Youth with T1D and celiac disease reported similar generic and diabetes-specific QoL to T1D only. GFD nonadherent vs adherent youth reported lower diabetes-specific QoL (mean score 58 vs 75, P = .003) and lower general well-being (57 vs 76, P = .02), as did their parents (50 vs 72, P = .006), and hemoglobin A1c was higher (9.6% vs 8.0%, P = .02). Youth with T1D and celiac disease using continuous subcutaneous insulin infusion vs multiple daily injections had similar generic and diabetes-specific QoL and A1C (8.6 vs 8.2%, P = .44), but were less happy having to follow a lifelong diet (59 vs 29, P = .007). Youth with T1D and celiac disease who do not adhere to the GFD have lower QoL and worse glycemic control. Novel strategies are required to understand and improve adherence in those with both conditions.

Greater diet quality is associated with more optimal glycemic control in a longitudinal study of youth with type 1 diabetes

Despite the centrality of nutrition in the management of type 1 diabetes, the association of diet quality and macronutrient distribution with glycemic control is ambiguous. This study examined longitudinally the association of dietary intake with multiple indicators of glycemic control in youth with type 1 diabetes participating in a behavioral nutrition intervention study. Participants in a randomized clinical trial of a behavioral nutrition intervention [n = 136; mean ± SD age: 12.8 ± 2.6 y; glycated hemoglobin (HbA1c): 8.1% ± 1.0%; 69.1% using an insulin pump] completed 3-d diet records at baseline and months 3, 6, 9, 12, and 18; masked continuous glucose monitoring (CGM) data were obtained concurrently with the use of the Medtronic iPro CGM system. HbA1c was obtained every 3 mo; 1,5-anhydroglucitol was obtained every 6 mo. Linear mixed-effects regression models estimated associations of time-varying dietary intake variables with time-varying glycemic control indicators, controlling for age, height, weight, sex, Tanner stage, diabetes duration, regimen, frequency of blood glucose monitoring, physical activity, and treatment assignment. HbA1c was associated inversely with carbohydrate and natural sugar, and positively with protein and unsaturated fat. 1,5-Anhydroglucitol was associated positively with fiber intake and natural sugar. Greater glycemic control as indicated by ≥1 CGM variable was associated with higher Healthy Eating Index-2005, whole plant food density, fiber, carbohydrate, and natural sugar and lower glycemic index and unsaturated fat. Both overall diet quality and macronutrient distribution were associated with more optimal glycemic control. Associations were more consistent for CGM variables obtained concurrently with dietary intake than for biomarkers of longer-term glycemic control. These findings suggest that glycemic control may be improved by increasing intake of high-fiber, low glycemic-index, carbohydrate-containing foods. This trial was registered at clinicaltrials.gov as NCT00999375.