The Association Between Diet Quality and Glycemic Outcomes Among People with Type 1 Diabetes

Melanie B Gillingham; Martin Chase Marak; Michael C Riddell; Peter Calhoun; Robin L Gal; Susana R Patton; Peter G Jacobs; Jessica R Castle; Mark A Clements; Francis J Doyle; Michael R Rickels; Corby K Martin

doi:10.1016/j.cdnut.2024.102146

The Association Between Diet Quality and Glycemic Outcomes Among People with Type 1 Diabetes

Curr Dev Nutr. 2024 Mar 26;8(4):102146. doi: 10.1016/j.cdnut.2024.102146. eCollection 2024 Apr.

Authors

Affiliations

¹ Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, United States.
² Jaeb Center for Health Research, Tampa, FL, United States.
³ School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Canada.
⁴ Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, FL, United States.
⁵ Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, United States.
⁶ School of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, OR, United States.
⁷ Department of Pediatrics, Endocrine/Diabetes Clinical Research, Children's Mercy Hospital, Kansas City, MO, United States.
⁸ Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States.
⁹ Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
¹⁰ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States.

Abstract

Background: The amount and type of food consumed impacts the glycemic response and insulin needs of people with type 1 diabetes mellitus (T1DM). Daily variability in consumption, reflected in diet quality, may acutely impact glycemic levels and insulin needs.

Objective: Type 1 Diabetes Exercise Initiative (T1DEXI) data were examined to evaluate the impact of daily diet quality on near-term glycemic control and interaction with exercise.

Methods: Using the Remote Food Photography Method, ≤8 d of dietary intake data were analyzed per participant. Diet quality was quantified with the Healthy Eating Index-2015 (HEI), where a score of 100 indicates the highest-quality diet. Each participant day was classified as low HEI (≤57) or high HEI (>57) based on the mean of nationally reported HEI data. Within participants, the relationship between diet quality and subsequent glycemia measured by continuous glucose monitoring (CGM) and total insulin dose usage was evaluated using a paired t-test and robust regression models.

Results: Two hundred twenty-three adults (76% female) with mean ± SD age, HbA1c, and body mass index (BMI) of 37 ± 14 y, 6.6% ± 0.7%, and 25.1 ± 3.6 kg/m², respectively, were included in these analyses. The mean HEI score was 56 across all participant days. On high HEI days (mean, 66 ± 4) compared with low HEI days (mean, 47 ± 5), total time in range (70-180 mg/dL) was greater (77.2% ± 14% compared with 75.7% ± 14%, respectively, P = 0.01), whereas time above 180 mg/dL (19% ± 14% compared with 21% ± 15%, respectively, P = 0.004), mean glucose (143 ± 22 compared with 145 ± 22 mg/dL, respectively, P = 0.02), and total daily insulin dose (0.52 ± 0.18 compared with 0.54 ± 0.18 U/kg/d, respectively, P = 0.009) were lower. The interaction between diet quality and exercise on glycemia was not significant.

Conclusions: Higher HEI scores correlated with improved glycemia and lower insulin needs, although the impact of diet quality was modest and smaller than the previously reported impact of exercise.

Keywords: Healthy Eating Index; Type 1 diabetes; diet quality; exercise; glycemia; humans; time in range.