DIETARY INTAKES BY LEVELS OF GLYCEMIC CONTROL FOR BLACK-AND-WHITE ADULTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS (NIDDM)

Objectives: The relationship between diet and glycemic control was exa mined among a racially mixed population of male and female adults with non-insulin dependent diabetes mellitus (NIDDM). Methods: Data from 3 -day dietary records and glycosylated hemoglobin (HbA(1c)) were analyz ed for two-hundred eighty two patients of a Family Practice Ambulatory Care Unit and a community-based health center in Winston-Salem, North Carolina. Correlations were calculated for individual nutrients to de termine their strength of association with glycemic control. Analyses by tertiles of HbA(1c) were also conducted for each race/gender group. Regression analysis was used to determine independent dietary predict ors of HbA(1c). Results: For all subjects, energy, energy per kilogram of body weight, fat, carbohydrates saturated fat, and cholesterol wer e significantly correlated with HbA(1c). Nutritional differences acros s tertile levels of HbA(1c) for all subjects were not significant. For black females, consumption of energy, protein and fat was significant ly higher among upper tertile subjects compared to the lowest tertile; and intake of energy, protein, fat, and saturated fat was significant ly correlated with HbA(1c) in this group. For black males, energy inta ke was highest among upper tertile subjects compared to those in the m iddle tertile, while energy per kilogram of body weight, and percent o f calories from protein, were significantly correlated with HbA(1c). F or white males, energy intake expressed as a function of body weight w as highest among subjects in the upper tertile and a significant posit ive correlation with HbA(1c) was observed. No relationship between nut ritional intake and HbA(1c) was found among white females. Racial diff erences in nutrient intake were also compared for males and females in the upper tertile of HbA(1c). Black females in the upper tertile cons umed significantly more energy, protein, and significantly less dietar y fiber per 1000 kilocalories. No significant differences were observe d between black and white males in the upper tertile, although higher cholesterol consumption in black males compared to white males approac hed significance. Regression analysis revealed that total energy intak e significantly predicted HbA(1c) for all subjects and all white subje cts, while a similar observation was made for total fat intake among a ll black subjects and among black females. Conclusions: These findings confirm that diet, especially total energy, is an important contribut or to glycemic control. Dietary fat is also associated with glycemic c ontrol among blacks, especially black females, who are especially pron e to more dire health consequences of NIDDM. Strict monitoring of diet should lead to improved glycemic control and less mortality and morbi dity in this population.