Decrease in Glycemic Index Associated with Improved Glycemic Control among Latinos with Type 2 Diabetes

Published:December 26, 2014DOI:



      Glycemic index and glycemic load are used to facilitate glucose control among adults with type 2 diabetes, with a low glycemic index diet associated with improved glycemic control.


      To examine long-term longitudinal associations between changes in glycemic index and glycemic load with glycemic and metabolic control among Latino adults with diabetes.


      Secondary data from intervention and comparison participants in the Latinos en Control trial (2006 to 2008) were analyzed.


      Data on dietary intake and metabolic characteristics were from low-income, Latino adults (N=238; 87.7% Puerto Rican) with type 2 diabetes.


      The Latinos en Control trial was a randomized clinical trial targeting diabetes self-management among Latinos with type 2 diabetes. Participants were randomized to a group-based behavioral intervention or usual care and followed through 12 months.

      Main outcome measures

      Outcomes included hemoglobin A1c (HbA1c) levels, fasting blood glucose, lipid profiles, anthropometrics, and blood pressure.

      Statistical analysis

      Glycemic index and load were analyzed using data from three 24-hour dietary recalls conducted at baseline, 4 months, and 12 months. Repeated measures regression models were used to examine change in glycemic index and load associated with metabolic characteristics at 12 months. Covariates included sex, age, body mass index, blood pressure, total energy intake, medication use and intensity, physical activity, intervention status (intervention vs usual care), and time.


      Increases in glycemic index from baseline to 12 months were associated with increased logarithm of HbA1c levels (β=0.003; P=0.034) and waist circumference (β=0.12; P=0.026) over time, but not with fasting glucose, blood lipids, or body mass index. There was modest evidence to support small, positive associations between glycemic load and HbA1c levels and waist circumference.


      Lowering glycemic index is associated with improvements in certain metabolic risk factors among Latinos with diabetes. Targeting glycemic index may be an important component of dietary strategies for diabetes self-management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention (CDC)
        National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014.
        US Department of Health and Human Services, Atlanta, GA2014
        • Gonzalez A.B.
        • Salas D.
        • Umpierrez G.E.
        Special considerations on the management of Latino patients with type 2 diabetes mellitus.
        Curr Med Res Opin. 2011; 27: 969-979
        • Kirk J.K.
        • Passmore L.V.
        • Bell R.A.
        • et al.
        Disparities in A1C levels between Hispanic and non-Hispanic white adults with diabetes: A meta-analysis.
        Diabetes Care. 2008; 31: 240-246
        • Boltri J.M.
        • Okosun I.S.
        • Davis-Smith M.
        • Vogel R.L.
        Hemoglobin A1c levels in diagnosed and undiagnosed black, Hispanic, and white persons with diabetes: Results from NHANES 1999-2000.
        Ethn Dis. 2005; 15: 562-567
        • Cowie C.C.
        • Rust K.F.
        • Ford E.S.
        • et al.
        Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006.
        Diabetes Care. 2009; 32: 287-294
        • Harris M.I.
        • Eastman R.C.
        • Cowie C.C.
        • Flegal K.M.
        • Eberhardt M.S.
        Racial and ethnic differences in glycemic control of adults with type 2 diabetes.
        Diabetes Care. 1999; 22: 403-408
      1. Centers for Disease Control and Prevention (CDC). Age-adjusted percentage of civilian, noninstitutionalized population with diagnosed diabetes, by Hispanic origin and sex, United States, 1997-2011. 2013; Accessed September 9 2014.

        • Suh D.C.
        • Choi I.S.
        • Plauschinat C.
        • Kwon J.
        • Baron M.
        Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988-1994 to 1999-2004.
        J Diabetes Complications. 2010; 24: 382-391
        • Vijayaraghavan M.
        • He G.
        • Stoddard P.
        • Schillinger D.
        Blood pressure control, hypertension, awareness, and treatment in adults with diabetes in the United States-Mexico border region.
        Rev Panam Salud Publica. 2010; 28: 164-173
        • Flood A.
        • Subar A.F.
        • Hull S.G.
        • Zimmerman T.P.
        • Jenkins D.J.
        • Schatzkin A.
        Methodology for adding glycemic load values to the National Cancer Institute Diet History Questionnaire database.
        J Am Diet Assoc. 2006; 106: 393-402
        • Jenkins D.J.
        • Wolever T.M.
        • Taylor R.H.
        • et al.
        Glycemic index of foods: A physiological basis for carbohydrate exchange.
        Am J Clin Nutr. 1981; 34: 362-366
        • Willett W.
        • Manson J.
        • Liu S.
        Glycemic index, glycemic load, and risk of type 2 diabetes.
        Am J Clin Nutr. 2002; 76: 274S-280S
        • Brand J.C.
        • Colagiuri S.
        • Crossman S.
        • Allen A.
        • Roberts D.C.
        • Truswell A.S.
        Low-glycemic index foods improve long-term glycemic control in NIDDM.
        Diabetes Care. 1991; 14: 95-101
        • Gutschall M.D.
        • Miller C.K.
        • Mitchell D.C.
        • Lawrence F.R.
        A randomized behavioural trial targeting glycaemic index improves dietary, weight and metabolic outcomes in patients with type 2 diabetes.
        Public Health Nutr. 2009; 12: 1845-1854
        • Jarvi A.E.
        • Karlstrom B.E.
        • Granfeldt Y.E.
        • Bjorck I.E.
        • Asp N.G.
        • Vessby B.O.
        Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients.
        Diabetes Care. 1999; 22: 10-18
        • Rizkalla S.W.
        • Taghrid L.
        • Laromiguiere M.
        • et al.
        Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: A randomized controlled trial.
        Diabetes Care. 2004; 27: 1866-1872
        • Wolever T.M.
        • Gibbs A.L.
        • Mehling C.
        • et al.
        The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: No effect on glycated hemoglobin but reduction in C-reactive protein.
        Am J Clin Nutr. 2008; 87: 114-125
        • Miller C.K.
        • Gutshcall M.D.
        • Mitchell D.C.
        Change in food choices following a glycemic load intervention in adults with type 2 diabetes.
        J Am Diet Assoc. 2009; 109: 319-324
        • Roberts C.K.
        • Liu S.
        Effects of glycemic load on metabolic health and type 2 diabetes mellitus.
        J Diabetes Sci Technol. 2009; 3: 697-704
        • Miller C.K.
        • Kristeller J.L.
        • Headings A.
        • Nagaraja H.
        • Miser W.F.
        Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study.
        J Acad Nutr Diet. 2012; 112: 1835-1842
        • Rosal M.C.
        • Ockene I.S.
        • Restrepo A.
        • et al.
        Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en control.
        Diabetes Care. 2011; 34: 838-844
        • Rosal M.C.
        • White M.J.
        • Restrepo A.
        • et al.
        Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-income Latinos: Latinos en Control.
        BMC Med Res Methodol. 2009; 9: 81
        • Rosal M.C.
        • White M.J.
        • Borg A.
        • et al.
        Translational research at community health centers: Challenges and successes in recruiting and retaining low-income Latino patients with type 2 diabetes into a randomized clinical trial.
        Diabetes Educ. 2010; 36: 733-749
        • Atkinson F.S.
        • Foster-Powell K.
        • Brand-Miller J.C.
        International tables of glycemic index and glycemic load values: 2008.
        Diabetes Care. 2008; 31: 2281-2283
        • Brand-Miller J.
        • Wolever T.M.S.
        • Foster-Powell K.F.
        • Colagiuri S.
        The New Glucose Revolution.
        Marlowe & Company, New York, NY2003
        • Rosal M.C.
        • Olendzki B.
        • Reed G.W.
        • Gumieniak O.
        • Scavron J.
        • Ockene I.
        Diabetes self-management among low-income Spanish-speaking patients: A pilot study.
        Ann Behav Med. 2005; 29: 225-235
        • Matthews C.E.
        • DuBose K.D.
        • LaMonte M.
        • Tudor-Locke C.
        • Ainsworth B.E.
        Evaluation of a computerized 24-hour physical activity recall (24PAR).
        Med Sci Sports Exer. 2002; 34 ([abstract]): S41
        • Wang M.L.
        • Lemon S.C.
        • Olendzki B.
        • Rosal M.C.
        Beverage-consumption patterns and associations with metabolic risk factors among low-income Latinos with uncontrolled type 2 diabetes.
        J Acad Nutr Diet. 2013; 113: 1695-1703
        • Wang M.L.
        • Lemon S.C.
        • Whited M.C.
        • Rosal M.C.
        Who benefits from diabetes self-management interventions? The influence of depression in the Latinos en Control Trial.
        Ann Behav Med. 2014; 48: 256-264
        • Jimenez-Cruz A.
        • Bacardi-Gascon M.
        • Turnbull W.H.
        • Rosales-Garay P.
        • Severino-Lugo I.
        A flexible, low-glycemic index mexican-style diet in overweight and obese subjects with type 2 diabetes improves metabolic parameters during a 6-week treatment period.
        Diabetes Care. 2003; 26: 1967-1970
        • Luscombe N.D.
        • Noakes M.
        • Clifton P.M.
        Diets high and low in glycemic index versus high monounsaturated fat diets: Effects on glucose and lipid metabolism in NIDDM.
        Eur J Clin Nutr. 1999; 53: 473-478
        • Thomas D.
        • Elliott E.J.
        Low glycaemic index, or low glycaemic load, diets for diabetes mellitus.
        Cochrane Database Syst Rev. 2009; : CD006296
        • Wheeler M.L.
        • Dunbar S.A.
        • Jaacks L.M.
        • et al.
        Macronutrients, food groups, and eating patterns in the management of diabetes: A systematic review of the literature, 2010.
        Diabetes Care. 2012; 35: 434-445
        • Heilbronn L.K.
        • Noakes M.
        • Clifton P.M.
        The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control.
        J Am Coll Nutr. 2002; 21: 120-127
        • McEwen M.M.
        • Pasvogel A.
        • Gallegos G.
        • Barrera L.
        Type 2 diabetes self-management social support intervention at the U.S.-Mexico border.
        Public Health Nurs. 2010; 27: 310-319
        • Stratton I.M.
        • Adler A.I.
        • Neil H.A.
        • et al.
        Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study.
        BMJ. 2000; 321: 405-412
        • Klein S.
        • Allison D.B.
        • Heymsfield S.B.
        • et al.
        Waist circumference and cardiometabolic risk: A consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association.
        Obesity (Silver Spring). 2007; 15: 1061-1067
        • Bornet F.R.
        • Jardy-Gennetier A.E.
        • Jacquet N.
        • Stowell J.
        Glycaemic response to foods: Impact on satiety and long-term weight regulation.
        Appetite. 2007; 49: 535-553
        • Franz M.J.
        • Powers M.A.
        • Leontos C.
        • et al.
        The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults.
        J Am Diet Assoc. 2010; 110: 1852-1889
        • Jenkins D.J.
        • Kendall C.W.
        • Augustin L.S.
        • et al.
        Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: A randomized controlled trial.
        Arch Intern Med. 2012; 172: 1653-1660
        • Post R.E.
        • Mainous 3rd, A.G.
        • King D.E.
        • Simpson K.N.
        Dietary fiber for the treatment of type 2 diabetes mellitus: A meta-analysis.
        J Am Board Fam Med. 2012; 25: 16-23
        • Pittas A.G.
        • Roberts S.B.
        • Das S.K.
        • et al.
        The effects of the dietary glycemic load on type 2 diabetes risk factors during weight loss.
        Obesity (Silver Spring). 2006; 14: 2200-2209
        • Olendzki B.C.
        • Ma Y.
        • Hebert J.R.
        • et al.
        Underreporting of energy intake and associated factors in a Latino population at risk of developing type 2 diabetes.
        J Am Diet Assoc. 2008; 108: 1003-1008


      M. L. Wang is an assistant professor, Department of Community Health Sciences, Boston University School of Public Health and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.


      L. Gellar is an associate professor, Department of Nursing and Health Professions, University of South Carolina Beaufort; at the time of the study, she was an assistant professor of public health nutrition, Department of Nutrition, University of Tennessee, Knoxville.


      B. H. Nathanson is chief executive officer, OptiStatim, LLC, Longmeadow, MA.


      L. Pbert is a professor of medicine, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.


      I. Ockene is a professor of medicine, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.


      M. C. Rosal is a professor of medicine, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.


      Y. Ma is an associate professor of medicine, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.