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The Effect of Flexible Low Glycemic Index Dietary Advice Versus Measured Carbohydrate Exchange Diets on Glycemic Control in Children With Type 1 Diabetes

¹ Department of Nutrition and Food Services, the
² Department of Clinical Epidemiology and Biostatistics, and the
³ Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne
⁴ Human Nutrition Unit, Department of Biochemistry, University of Sydney
⁵ Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia

OBJECTIVE—To determine the long-term effect of low glycemic index dietary advice on metabolic control and quality of life in children with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Children with type 1 diabetes (n = 104) were recruited to a prospective, stratified, randomized, parallel study to examine the effects of a measured carbohydrate exchange (CHOx) diet versus a more flexible low–glycemic index (GI) dietary regimen on HbA_1c levels, incidence of hypo- and hyperglycemia, insulin dose, dietary intake, and measures of quality of life over 12 months.

RESULTS—At 12 months, children in the low-GI group had significantly better HbA_1c levels than those in the CHOx group (8.05 ± 0.95 vs. 8.61 ± 1.37%, P = 0.05). Rates of excessive hyperglycemia (>15 episodes per month) were significantly lower in the low-GI group (35 vs. 66%, P = 0.006). There were no differences in insulin dose, hypoglycemic episodes, or dietary composition. The low-GI dietary regimen was associated with better quality of life for both children and parents.

CONCLUSIONS—Flexible dietary instruction based on the food pyramid with an emphasis of low-GI foods improves HbA_1c levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes.

Abbreviations: BMR, basal metabolic rate • CHOx, carbohydrate exchange • GI, glycemic index • NMES, nonmilk extrinsic sugars • RCH, Royal Children’s Hospital

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