LIBERALIZED DIET IN PATIENTS WITH TYPE-1 DIABETES

Objective. To document that strict dietary regimen are not necessary i n the context of intensified insulin therapy. Design. German multicent re, prospective cohort study; 6 years follow-up. Setting. Ambulatory e xamination using a mobile ambulance. Subjects, A total of 636 type 1 d iabetic patients (age 33+/-7 years, diabetes duration 15+/-7 years; me an+/-SD), who had participated in a structured, 5-day, in-patient, gro up treatment and teaching programme for intensification of insulin the rapy and liberalization of the diabetes diet 6 years prior to follow-u p. Main outcome measures. Relations between the extent to which patien ts practise a liberalized diet, the degree of metabolic control (HbAlc , severe hypoglycaemia, body mass index, cholesterol), and the patient s' perceived burden through dietary treatment. Results. In the total p atient group, HbAlc was 7.9+/-1.6%, and the incidence of severe hypogl ycaemia was 0.17 cases per patient during the preceding year; 31% pati ents injected insulin less than or equal to 3 times per day, 58% 4-7 t imes per day, and 11% used insulin pump therapy. Only 11% patients rep orted following a meal plan, whereas 89% continually changed timing an d amount of carbohydrate intake; only 5% had the same number of meals every day, whereas as many as 20% varied the number of meals per day b y four or more; 53% skipped main meals; 85% habitually consumed sugar or sugar containing foods. Patients with a higher degree of diet liber alization injected insulin or used an insulin pump therapy more freque ntly, and perceived their dietary treatment to be less burdensome. No clinically significant associations were found between the extent of d iet liberalization and metabolic control. Conclusions. Under the condi tions where type 1 diabetic patients have the opportunity to participa te in an intensified insulin treatment and teaching programme, liberal ization of the diabetes diet is not associated with adverse effects on glycaemic control, but is associated with less perceived burden throu gh dietary treatment.