Type 1 diabetes

Diet and weight a concern for children with T1D, audit suggests

Children with type 1 diabetes are avoiding carbs but consume too much sugar and fat and are overweight, an audit by dieticians at a Victorian diabetes centre has found.

Surveys completed for 429 children aged 2-17 with diabetes attending the Royal Children’s Hospital in Melbourne showed that 30% were overweight and all of them had excessive energy intake.

The findings, published in Nutrition and Diabetes, showed that carbohydrates accounted for a lower proportion of macronutrient intake than currently recommended (48.6% vs 50-55% recommended). The children had a high intake of simple sugars (22.4% vs a recommended level of < 10% ), saturated fat (14.9% vs <10%) and protein (19.1% vs 10-15%).

The dieticians said the overall quality of the childrens’ diet was  nutritionally adequate and comparable to the non-diabetic peer group.

However the high rates of overweight were a concern and should be addressed through more interventions – particular aimed at adolescents among whom dietary intake worsened over time, they said.

“Nutrition education needs to be targeted to avoid overfeeding the diabetes to the health detriment of the individual,” they wrote.

The high rates of overweight may also have been due to children using higher insulin doses to try achieve intensive glycaemia control, they suggested.

“Potentially too much emphasis is placed on daily glycaemic targets and increasing insulin doses to improve control and not enough focus on improving the quantity and quality of foods consumed,” they said.

“With increased awareness now of this association, dietetic interventions in the clinic setting can focus more specifically on this issue. Other clinicians in the multidisciplinary team may also be mindful of this inter-relationship before increasing insulin doses.”

The audit showed that only 43% of children met the target for good glycaemia control, and that children using insulin pumps had better HbA1c outcomes.

“Dietitians must focus on weight management, specifically reducing dietary fat intake and improving the nutritional adequacy overall, with targeted intensive education to the 4–13 years old group to prevent excessive energy intake that is likely to be detrimental to diabetes-related health outcomes later in life,” they concluded..

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