Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-115010
© Georg Thieme Verlag KG Stuttgart · New York

Eating Frequency and Carbohydrate Intake in Adolescents with Type 1 Diabetes Differ from Those in Their Peers and are Associated with Glycemic Control

Christina Baechle1, 4, Annika Hoyer1, 4, Katty Castillo-Reinado1, 4, Anna Stahl-Pehe1, 4, Oliver Kuss1, 4, Reinhard W. Holl2, 4, Mathilde Kersting3, Joachim Rosenbauer1, 4, In cooperation with the German Pediatric Surveillance Unit (ESPED) and the DPV-Science initiative, supported by the German Center for Diabetes Research (DZD)
  • 1German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
  • 2Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
  • 3Research Institute of Child Nutrition (FKE), Pediatric University Clinic Bochum, University of Bonn, Bochum, Germany
  • 4German Center for Diabetes Research (DZD), München-Neuherberg, Germany
Further Information

Publication History

received 29 March 2017
revised 27 June 2017

accepted 27 June 2017

Publication Date:
11 September 2017 (eFirst)


Aim The diet of people with type 1 diabetes may differ from that of healthy peers due to disease-related factors that may affect the course of diabetes. This cross-sectional study sought to compare meal and snacking frequency and corresponding carbohydrate intake among adolescents with intensively-treated type 1 diabetes and healthy peers and to analyze their association with glycemic control among diabetes patients.

Methods Nutritional data of 712 11- to <19-year-olds from a nationwide population-based survey on early-onset type 1 diabetes (52.7% boys/men, mean age 15.6 years) were compared with 949 food records of 296 healthy participants in the DONALD cohort study (49.7% boys, mean age 14.4 years) using linear mixed models. Furthermore, the association between eating frequency and/or carbohydrate intake with glycemic control (HbA1c) was analyzed with multiple linear regression models.

Results After comprehensive adjustment, diabetes patients had, on average, 4.6 [95% confidence interval 3.6, 5.5] more meals or snacks/week but consumed 75.9 [64.5, 87.3] fewer grams of carbohydrates/day than the comparison group. Diabetes subjects also consumed breakfast, lunch, dinner, and snacks more frequently but ate fewer carbohydrates at all eating occasions. Total carbohydrate intake and carbohydrate intake at breakfast were associated with higher HbA1c levels, while increased breakfast frequency was associated with lower HbA1c levels.

Conclusion Eating frequency and carbohydrate intake differed between adolescents with early-onset type 1 diabetes and non-diabetic peers. The observed associations with glycemic control challenge the concept of a completely unregulated eating frequency and carbohydrate intake for people on intensified insulin therapy.