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Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids^1,2,3

¹ From the Clinical Department, German Diabetes Research Institute at the Heinrich-Heine-University, Düsseldorf, Germany; the Diabetes Center, Athens Medical School, Hippokration Hospital, Athens, Greece; University Hospital of Gent, Gent, Belgium; the Division of Endocrinology and Metabolic Disease, University of Verona, Verona, Italy; and the Department of Epidemiology and Public Health, University College London Medical School, London.

Background: Little is known about the variation of the glycemic index (GI) in the diet of European outpatients with type 1 diabetes and how the GI of a commonly consumed diet is associated with metabolic control.

Objective: The present study examined the calculated dietary GI of European outpatients with type 1 diabetes for possible relations to glycated hemoglobin (Hb A_1c) and serum lipid concentrations.

Design: The relation of the GI (calculated from a 3-d dietary record) to Hb A_1c, serum cholesterol (total, LDL, and HDL), and fasting triacylglycerol was analyzed in 2810 people with type 1 diabetes from the EURODIAB Complications Study.

Results: The GI was independently related to Hb A_1c (P = 0.0001). Compared with the highest GI quartile (median GI: 89), adjusted Hb A_1c in the lowest GI quartile (median GI: 75) was 11% lower in patients from southern European centers and 6% lower in patients from northern, western, and eastern European centers. Of the serum lipids, only the HDL cholesterol in patients from these European centers was independently related to the GI (P = 0.002). In southern European centers, the consumption of pasta, temperate-climate fruit, white bread, and potatoes largely determined the patients' dietary GI, whereas in the northern, western, and eastern European centers, consumption of bread, potatoes, and temperate-climate fruit was most relevant.

Conclusions: This study in European patients with type 1 diabetes showed that a lower dietary GI is related to lower Hb A_1c concentrations, independently of fiber intake. The consumption of bread and pasta had the biggest effect on the overall dietary GI of European outpatients.

Key Words: Glycemic index • type 1 diabetes • glycated hemoglobin • Hb A_1c • LDL cholesterol • HDL cholesterol • triacylglycerol • Europe • carbohydrate sources

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