Nutritional intake characteristics and glycemic control in patients with type 2 diabetes mellitus

Abstract

BACKGROUND

Optimal nutritional status is fundamental to the effective management of type 2 diabetes mellitus (T2DM); nonetheless, many patients encounter difficulties in maintaining a balanced diet that aligns with clinical recommendations. Imbalances in energy, macronutrient, and micronutrient intake remain prevalent and may contribute to suboptimal glycemic control.

AIM

To investigate the nutritional intake profile of patients with T2DM, compare dietary and clinical characteristics according to glycemic control status, and identify clinical and demographic factors independently associated with poor glycemic control.

METHODS

This single-center cross-sectional study enrolled 125 patients with T2DM, whose dietary intake was assessed using a 24-hour dietary recall. A three-tier analytical approach was implemented. First, nutrient intake was quantified using standardized food composition tables and compared against the recommended nutrient intakes (RNIs) established by the Chinese Nutrition Society. Patients were then stratified into well-controlled (HbA1c ≤ 7.0%) and poorly controlled (HbA1c > 7.0%) groups based on glycated hemoglobin (HbA1c) levels. Multivariable logistic regression models were constructed to evaluate the associations of total energy intake and carbohydrate energy percentage with poor glycemic control, with adjustment for demographic and clinical covariates, including antidiabetic treatment regimen. A secondary model additionally adjusted for total cholesterol.

RESULTS

Overall nutritional intake was characterized by total energy, protein, and carbohydrate consumption below recommended levels, alongside a relatively high fat intake. The majority of micronutrients—including vitamins A, D, E, B₁, B₂, and C, as well as essential minerals such as calcium, magnesium, zinc, and selenium—were significantly below the RNIs, whereas sodium and iron intakes were excessive. Dietary fiber intake was less than half of the recommended level. In multivariable analysis, each 100-kcal/day increment in total energy intake was independently associated with a greater odds of poor glycemic control after adjustment for age, sex, body mass index (BMI), diabetes duration, educational level, and antidiabetic treatment regimen [odds ratio (OR) = 1.536, 95% confidence interval (CI): 1.176–2.005, P = 0.002]. This association remained significant after further adjustment for total cholesterol (OR = 1.491, 95%CI: 1.134–1.960, P = 0.004). In contrast, carbohydrate energy percentage was not independently associated with poor glycemic control in either adjusted model (P = 0.069 and P = 0.081, respectively). Higher BMI was also associated with greater odds of poor glycemic control, whereas educational level and antidiabetic treatment regimen showed significant associations with glycemic status. Total cholesterol was not independently associated with poor glycemic control in the fully adjusted model (P = 0.110).

CONCLUSION

Patients with T2DM in this cohort exhibited substantial nutritional imbalances, characterized by inadequate dietary fiber and micronutrient intake, along with a relatively high proportion of energy derived from fat. Multivariable analysis further identified higher BMI as a factor associated with greater odds of poor glycemic control, while educational level and antidiabetic treatment regimen were significantly associated with glycemic status. These findings underscore the importance of individualized nutritional assessment integrated within comprehensive clinical management for patients with T2DM.

Keywords: Type 2 diabetes mellitus; Nutritional status; Glycated hemoglobin; Dietary intake; Correlation

Core Tip: This study revealed substantial dietary imbalances among patients with type 2 diabetes mellitus. In unadjusted analyses, patients with poor glycemic control exhibited higher total energy intake and greater absolute carbohydrate-derived energy intake. After adjustment for demographic and clinical covariates—including antidiabetic treatment regimen—higher total energy intake remained independently associated with increased odds of poor glycemic control, whereas the percentage of energy derived from carbohydrates was not independently associated. This association with total energy intake persisted after further adjustment for total cholesterol, indicating robustness to additional metabolic confounding. Higher body mass index was also independently associated with poor glycemic control, while educational level and antidiabetic treatment regimen showed significant overall associations with glycemic status. Collectively, these findings underscore total energy intake as a clinically relevant nutritional factor within the broader context of comprehensive diabetes management, distinct from carbohydrate composition alone.