Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth-onset type 1 and type 2 diabetes: TheSEARCHfor diabetes in youth study

Aims Examine associations of dietary strategies used to manage diabetes over time with hemoglobin A1c in youth-onset type 1 or type 2 diabetes. Methods The SEARCH for Diabetes in Youth observational study assessed dietary strategies used by 1814 participants with diabetes (n = 1558 type 1, n = 256 type 2) at two to three research visits over 5.5 years (range 1.7-12.2). Participants reported often, sometimes, or never using 10 different dietary strategies, and use over time was categorized into five mutually exclusive groups: often using across visits; started using at later visits; sometimes using across visits; stopped using at later visits; or never using across visits. General multivariable linear models evaluated most recent A1c by use category for each strategy. Results In type 1 diabetes, A1c was lower among those who starting tracking calories (-0.4%, TukeyP < .05), often counted carbs (-0.8%, TukeyP < .001), or sometimes chose low glycemic index foods (-0.5%, TukeyP= .02) vs those with less use, while participants who never drank more milk had the lowest A1c (-0.5%, TukeyP= .04). In type 2 diabetes, A1c was lower among those who often limited high fat foods (-2.0%, TukeyP= .02) or started counting carbohydrates (-1.7%, TukeyP= .07) than those who did so less. Conclusions For several dietary strategies, more frequent use over time was related to lower A1c in youth-onset type 1 and type 2 diabetes, suggesting these strategies can likely support diabetes management for this population. Investigation into factors predicting receipt of advice for specific strategies and corresponding impact on intake might be considered.