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Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial

¹ From the Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA (LMD, DMN, and DJW); the George Washington University Biostatistics Center, Rockville, MD (JML and PAC); the Harvard School of Public Health, Boston, MA (FBH); the Mayo Clinic, Rochester, MN (GKZ); and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (JW-R).

² Supported by an NIH Career Development Award K23 DK 080 228 (DJW).

³ Reprints not available. Address correspondence to DJ Wexler, Massachusetts Hospital Diabetes Center, Bulfinch 408, Boston, MA 02114. E-mail: dwexler{at}partners.org.

for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications

Background: Persons with type 1 diabetes have received widely varying dietary advice based on putative effects on glycemic control.

Objective: The objective was to determine whether diet composition was associated with subsequent glycated hemoglobin (Hb A_1c) concentrations during intensive therapy for type 1 diabetes.

Design: We examined associations between quantiles of dietary intake and Hb A_1c adjusted for age and sex in 532 intensively treated participants in the Diabetes Control and Complications Trial (DCCT) who had complete dietary data through 5 y of follow-up. Multivariate macronutrient density linear regression models tested the association of Hb A_1c at year 5 with macronutrient composition and were adjusted for age, sex, exercise, triglyceride concentration, body mass index (BMI), baseline Hb A_1c, and concurrent insulin dose.

Results: Higher insulin dose, lower carbohydrate intake, and higher saturated, monounsaturated, and total fat intakes were associated with higher Hb A_1c concentrations at year 5. In age- and sex-adjusted multivariate macronutrient models, substitution of fat for carbohydrate was associated with higher Hb A_1c concentrations (P = 0.01); this relation remained significant after adjustment for exercise level, serum triglycerides, and BMI (P = 0.02) but was no longer significant (P = 0.1) after adjustment for baseline Hb A_1c and concurrent insulin dose.

Conclusion: Among intensively treated patients with type 1 diabetes, diets higher in fat and saturated fat and lower in carbohydrate are associated with worse glycemic control, independent of exercise and BMI.

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