In the Journals

Routine mealtimes, preprandial insulin help children with type 1 diabetes achieve glycemic targets

Young children with type 1 diabetes who adhere to a routine eating pattern and receive insulin before meals are more likely to achieve glycemic targets than children who snack throughout the day, according to findings published in BMJ Open Diabetes Research & Care.

Rowen Seckold

“Very young children with type 1 diabetes can achieve target HbA1c if they follow a routine pattern of eating and use preprandial insulin dosing,” Rowen Seckold, MBBS, FRACP, advanced trainee in pediatric endocrinology at John Hunter Children’s Hospital in New South Wales, Australia, told Endocrine Today. “However, fruit and vegetable intake remains a concern in this young age group.”

In a retrospective, cross-sectional review, Seckold and colleagues analyzed medical records of 22 children aged 7 years and younger with type 1 diabetes receiving care at a pediatric diabetes clinic in Newcastle, Australia (mean age, 5 years; 55% boys; mean HbA1c, 6.4%; mean diabetes duration, 1.7 years). Parents completed a 3-day, weighed food diary that documented all food and drink consumed, including type of food and brand name, the measured amount of food offered either via scales or food cups, the amount of food consumed and the preparation method. Researchers analyzed food diaries for total energy and nutrient intakes using nutrient analysis software. Parents also completed a 16-item questionnaire defining diabetes management routines at mealtimes and eating patterns.

Within the cohort, 95% of children used preprandial insulin.

Mean macronutrient distribution (defined at percentage of energy intake) was 48% carbohydrate, 16% protein and 33% fat, including 15% saturated fat. All children ate at least three meals per day, and 81% also reportedly ate both morning and afternoon snacks. Most parents identified an eating pattern where the parent determined the number of times their child was offered food during the day (81%), according to researchers, with the remaining parents reporting children were offered food in a “grazing” pattern led by the child. No child met vegetable recommendations, and 28% met lean meat and protein recommendations.

Insulin Adolescent 2019 
Young children with type 1 diabetes who adhere to a routine eating pattern and receive insulin before meals are more likely to achieve glycemic targets than children who snack throughout the day
Source: Adobe Stock

The researchers found no correlation between HbA1c and daily total carbohydrate, protein or fat intake (P > .05). However, HbA1c was higher among children offered food in a grazing pattern compared with those offered regular meals (mean 7.7% vs. 6.1%; P = .01).

The researchers noted that the carbohydrate, protein, fat and saturated fat contents of meals were similar to general population data for the same age group, suggesting that children are eating diets similar to peers without diabetes.

“The clinical implications of this are that eating in a routine pattern is associated with lower HbA1c, suggesting that avoidance of grazing or continuous snacking is beneficial to diabetes management in this young age group,” Seckold told Endocrine Today. “Further research into dietary interventions to improve diet quality in young children is required.” – by Regina Schaffer

For more information:

Rowen Seckold, MBBS, FRACP, can be reached at John Hunter Hospital, Pediatric Diabetes and Endocrinology, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia; email: rowen.seckold@health.nsw.gov.au.

Disclosures: The authors report no relevant financial disclosures.

Young children with type 1 diabetes who adhere to a routine eating pattern and receive insulin before meals are more likely to achieve glycemic targets than children who snack throughout the day, according to findings published in BMJ Open Diabetes Research & Care.

Rowen Seckold

“Very young children with type 1 diabetes can achieve target HbA1c if they follow a routine pattern of eating and use preprandial insulin dosing,” Rowen Seckold, MBBS, FRACP, advanced trainee in pediatric endocrinology at John Hunter Children’s Hospital in New South Wales, Australia, told Endocrine Today. “However, fruit and vegetable intake remains a concern in this young age group.”

In a retrospective, cross-sectional review, Seckold and colleagues analyzed medical records of 22 children aged 7 years and younger with type 1 diabetes receiving care at a pediatric diabetes clinic in Newcastle, Australia (mean age, 5 years; 55% boys; mean HbA1c, 6.4%; mean diabetes duration, 1.7 years). Parents completed a 3-day, weighed food diary that documented all food and drink consumed, including type of food and brand name, the measured amount of food offered either via scales or food cups, the amount of food consumed and the preparation method. Researchers analyzed food diaries for total energy and nutrient intakes using nutrient analysis software. Parents also completed a 16-item questionnaire defining diabetes management routines at mealtimes and eating patterns.

Within the cohort, 95% of children used preprandial insulin.

Mean macronutrient distribution (defined at percentage of energy intake) was 48% carbohydrate, 16% protein and 33% fat, including 15% saturated fat. All children ate at least three meals per day, and 81% also reportedly ate both morning and afternoon snacks. Most parents identified an eating pattern where the parent determined the number of times their child was offered food during the day (81%), according to researchers, with the remaining parents reporting children were offered food in a “grazing” pattern led by the child. No child met vegetable recommendations, and 28% met lean meat and protein recommendations.

Insulin Adolescent 2019 
Young children with type 1 diabetes who adhere to a routine eating pattern and receive insulin before meals are more likely to achieve glycemic targets than children who snack throughout the day
Source: Adobe Stock

The researchers found no correlation between HbA1c and daily total carbohydrate, protein or fat intake (P > .05). However, HbA1c was higher among children offered food in a grazing pattern compared with those offered regular meals (mean 7.7% vs. 6.1%; P = .01).

The researchers noted that the carbohydrate, protein, fat and saturated fat contents of meals were similar to general population data for the same age group, suggesting that children are eating diets similar to peers without diabetes.

“The clinical implications of this are that eating in a routine pattern is associated with lower HbA1c, suggesting that avoidance of grazing or continuous snacking is beneficial to diabetes management in this young age group,” Seckold told Endocrine Today. “Further research into dietary interventions to improve diet quality in young children is required.” – by Regina Schaffer

For more information:

Rowen Seckold, MBBS, FRACP, can be reached at John Hunter Hospital, Pediatric Diabetes and Endocrinology, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia; email: rowen.seckold@health.nsw.gov.au.

Disclosures: The authors report no relevant financial disclosures.