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Journal of the American College of Nutrition, Vol. 18, No. 3, 242-247 (1999)
Published by the American College of Nutrition

Original Paper

Day-to-Day Consistency in Amount and Source of Carbohydrate Intake Associated with Improved Blood Glucose Control in Type 1 Diabetes

Thomas M.S. Wolever, MD, PhD, FACN,, Safa Hamad, MSc, Jean-Louis Chiasson, MD, Robert G. Josse, MD,, Lawrence A. Leiter, MD,, N. Wilson Rodger, MD, Stuart A. Ross, MD and Edmond A. Ryan, MD

Department of Nutritional Sciences, University of Toronto, Division of Endocrinology and Metabolism, St. Michael’s Hospital (T.M.S.W., R.G.J., L.A.L.), Toronto, Onario, Research Centre, CHUM
Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital (T.M.S.W., S.H., R.G.J., L.A.L.), Toronto, Onario, Research Centre, CHUM
Hôtel-Dieu de Montreal Hospital, Montreal, Quebec (J.-L.C.), CANADA
St. Joseph’s Health Centre, University of Western Ontario, London, Ontario (N.W.R.), CANADA
Diabetes Education and Research Centre, Calgary (S.A.R.), CANADA
Heritage Medical Research Centre, University of Alberta, Edmonton, Alberta (E.A.R.), CANADA

Address reprint requests to: Dr. Thomas MS Wolever, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada M5S 3E2

Objective: To determine if a relationship exists between blood glucose control and variability in nutrient intake from day-to-day in subjects with type 1 diabetes.

Methods: Two three-day diet records and one measurement of glycated hemoglobin (HbA1c) were obtained from 272 subjects with type 1 diabetes treated with a mixture of regular and NPH insulins before breakfast and supper and using a standardized algorithm to adjust insulin dose according to the results of self-monitoring of blood glucose two to four times daily. Day-to-day variation in nutrient intake was expressed as the coefficient of variation (CV=SDx100/mean).

Results: Nutrient intakes in the study population (mean±SD) were energy 8.35±2.43 MJ, fat 81±30 g, protein 94±28 g, carbohydrate 227±68 g, starch 126±38 g and dietary fiber 20±6 g with diet glycemic index being 84.2±7.4. Neither energy, nutrient intakes nor insulin dose was significantly related to HbA1c. Day-to-day variation of carbohydrate (p=0.0097) and starch (p=0.0016) intakes and diet glycemic index (p=0.033) was positively related to HbA1c, and the associations remained significant when adjusted for age, sex, duration of diabetes and BMI. Day-to-day variation in energy, protein or fat intakes was not related to HbA1c.

Conclusions: Consistency in the amount and source of carbohydrate intake from day-to-day is associated with improved blood glucose control in people with type 1 diabetes, a result which supports continued educational efforts to achieve adherence to a diabetes diet plan. This conclusion may not apply to people on intensified insulin therapy who adjust their insulin dose based on their actual carbohydrate intake at each meal.

Key words: diet, humans, type 1 diabetes, carbohydrate, glycemic index, blood glucose control




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