Food Label Use, Diet Quality and Glycemic Control among Individuals with Type 2 Diabetes

BACKGROUND A significant proportion of individuals with diabetes have difficulty managing their diet and glucose levels. Nutritional and/or health information found on food labels of pre-packaged foods is likely to be key in helping individuals with type 2 diabetes make healthier food choices. Food label associated positive dietary changes may lead to better glycemic control. Moreover, among individuals without diabetes, food label use may reduce risk of diabetes development. Current literature lacks evidence linking food label use with blood glucose control or diabetes incidence.;OBJECTIVES, METHODOLOGY, AND RESULTS The overall goal of this dissertation was to examine the impact of food label use on dietary quality and glycemic control among participants with type 2 diabetes or prediabetes. The specific objectives for the first study (cross-sectional study, N=203) were to identify determinants of food label use among Latinos with type 2 diabetes, and to define the association between food label use and diet among them. We observed that food label use was associated with a healthy dietary pattern (factor analyses and median regression), and that the association between food label use and diet quality is stronger among individuals with better diet quality (quantile regression).;The second study identified the positive impact of diabetes-specific education delivered via community health workers, on food label use (mixed modeling). We also identified that food label use and diet quality positively mediated improved blood glucose levels among the intervention group (mediation modeling).;Further, in the third study, we compared the associations between the use of two forms of food labels (nutrition facts panel and health claims), independently and together, and diet quality and blood glucose levels among participants with prediabetes [N=2654; 2005-2010 National Health and Nutrition Examination Surveys (cross-sectional study)]. In this study, use of both-labels, or using health-claims without also consulting the nutrition facts panel for food selection was associated with poorer diet quality and glucose levels (weighted linear regression).;Lastly, in the fourth study, we tested prospectively the role of food label use on future diabetes diagnosis risk among 7,150 young adults without diabetes at baseline and observed that among food label users (vs. non-users), the hazard rate ratio of diabetes diagnosis risk decreased significantly with time (extended cox regression).;CONCLUSIONS This dissertation addressed various existing gaps in our understanding about the association between food label use and glucose control among individuals with type 2 diabetes, or at high risk for future type 2 diabetes. In the context of an efficient regulatory system that mandates food labels on all processed foods which represent the great majority of foods consumed in the US and many other countries, the scientific information gained from this dissertation may motivate policymakers, health care providers, nutritionists, and people with type 2 diabetes to recommend or make positive dietary choices via food label use.