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  • Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial

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Clinical care/Education/Nutrition
Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial
  1. Sofia Sterner Isaksson1,2,
  2. Margareta Bensow Bacos3,
  3. Björn Eliasson1,
  4. Eva Thors Adolfsson4,
  5. Araz Rawshani1,
  6. Ulf Lindblad5,
  7. Johan Jendle6,
  8. Agneta Berglund3,
  9. Marcus Lind1,2,
  10. Mette Axelsen3
  1. 1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Medicine, NU Hospital Group, Uddevalla, Sweden
  3. 3Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4Centre for Clinical Research, Region Västmanland, Uppsala University, Uppsala, Sweden
  5. 5School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
  6. 6Institution of Medical Sciences, Örebro University, Orebro, Sweden
  1. Correspondence to Sofia Sterner Isaksson; sofia.c.isaksson{at}vgregion.se

Abstract

Introduction Evidence on the effects of structured nutrition education is weak in adults with type 1 diabetes mellitus (T1D) with moderately impaired glycemic control. Objective was to compare the effects of different types of nutrition education programs on glycemic control, cardiovascular risk factors, quality of life, diet quality and food choices in T1D.

Research design and methods A 12 months randomized controlled study conducted at nine diabetes specialist centers with three parallel arms: (i) a food-based approach (FBA) including foods with low glycemic index or (ii) carbohydrate counting (CC) according to today’s standard practice or (iii) individual sessions according to routine care (RC). The primary end point was difference in glycated hemoglobin A1c (HbA1c) between groups at 12 months.

Results 159 patients were randomized (FBA: 51; CC: 52; RC: 55). Mean (SD) age 48.6 (12.0) years, 57.9% females and mean (SD) HbA1c level 63.9 (7.9) mmol/mol, 8% (0.7%). After 3 months, HbA1c improved in both FBA and CC compared with RC. However, there were no significant differences at 12 months in HbA1c; FBA versus RC (−0.4 mmol/mol (1.3), 0.04% (0.1%)), CC versus RC (−0.8 mmol/mol (1.2), 0.1% (0.1%)), FBA versus CC (0.4 mmol/mol (0.3), 0.04% (0.01%)). At 12 months, intake of legumes, nuts and vegetables was improved in FBA versus CC and RC. FBA also reported higher intake of monounsaturated and polyunsaturated fats compared with RC, and dietary fiber, monounsaturated and polyunsaturated fats compared with CC (all p values <0.05). There were no differences in blood pressure levels, lipids, body weight or quality of life.

Conclusions Nutrition education using an FBA, CC or RC is equivalent in terms of HbA1c and cardiovascular risk factors in persons with T1D with moderately impaired glycemic control. An FBA had benefits regarding food choices compared with CC and RC.

  • diabetes mellitus
  • type 1
  • diet therapy
  • education
  • diet
  • diabetic

Data availability statement

Data are available on reasonable request. Data consist of deidentified participant data. Contact person is Mette Axelsen, email: axelsen.nutrition@gmail.com

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001971

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    Data availability statement

    Data are available on reasonable request. Data consist of deidentified participant data. Contact person is Mette Axelsen, email: axelsen.nutrition@gmail.com

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    Footnotes

    • Contributors AB, BE, MA, MBB, ML, ETA and UL designed the study. MA and MBB performed the study. AR and SSI performed the statistical analyses and analyzed the data. MA and SSI wrote the manuscript and had responsibility for the final content of the manuscript. All authors contributed to the manuscript by reading, editing and approving the final manuscript. None of the authors reported a conflict of interest related to the study.

    • Funding This study was supported by The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, The Swedish Diabetes Foundation, Lantmännen Research Foundation, NovoNordisk Foundation and Swedish State (ALF grant).

    • Disclaimer The sponsors did not have any role in the design and conduct of the study, collection, management, analysis and interpretation of the data and preparation, review or approval of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.