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

  1. Heather R. Gilbertson, GDD1,
  2. Jennie C. Brand-Miller, PHD4,
  3. Anne W. Thorburn, PHD5,
  4. Sharon Evans, MND1,
  5. Patty Chondros, MSC2 and
  6. George A. Werther, MD3
  1. 1Department of Nutrition and Food Services, the
  2. 2Department of Clinical Epidemiology and Biostatistics, and the
  3. 3Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne
  4. 4Human Nutrition Unit, Department of Biochemistry, University of Sydney
  5. 5Department 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 HbA1c 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 HbA1c 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 HbA1c levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes.


    • Address correspondence and reprint requests to Heather R. Gilbertson, Department of Nutrition and Food Services, Women’s and Children’s Health Care Network, Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia 3052. E-mail: gilberth{at}

      Received for publication 19 October 2000 and accepted in revised form 26 March 2001.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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