Grazing in Young Children with Type 1 Diabetes Is Associated with Higher HbA1c

Abstract

Glycemic control in the young child with type 1 diabetes (T1D) has traditionally been challenging. Unpredictability in appetite and dietary intake has made the achievement of glycemic targets difficult. This study aimed to assess the nutritional quality and dietary behaviors of young children with T1D that attend a clinic that meets glycemic targets in this age group. Carers of children aged <7 years with type 1 diabetes attending a specialist Pediatric Diabetes Service in Australia completed a 3 day food diary and a survey regarding diabetes management and dietary behaviours. Twenty one children participated (mean age: 4.7 ±1.3y, 57% male, mean BMI z score: 0.9 ± 0.9, duration since diagnosis 1.6 ±1.1y, 38% insulin pump therapy, mean HbA1c: 6.3 ± 0.7% (45±7mmol/mol)). Offering food ’whenever they are hungry’ was associated with higher HbA1c than routine meals (7.2% vs. 6.1%, p=0.02). HbA1c was not correlated with daily total CHO intake, which ranged from 126g to 236g/day. Almost all carers (95%) gave mealtime insulin before food. Most carers (55%) substituted when 6-10 grams (range 1g to >15g) of CHO less than the predicted quantity was consumed. Children consumed saturated fat in excess of recommendations (15 ± 3% E) with no children meeting recommended serves of vegetables. Young children with type 1 diabetes can achieve target glycemic control and can safely dose insulin before meals. Continuous eating episodes were positively associated with HbA1c. Dietary quality remains a concern in this age group. Disclosure R.L. Seckold: None. P. Howley: None. B.R. King: None. K. Bell: Other Relationship; Self; Novo Nordisk Inc.. C.E. Smart: None.