ESPE Abstracts

Background: Carbohydrate counting is essential in diabetes management to match insulin doses to carbohydrate intake. Though recommendations concerning macronutritient composition exist (ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes), fat and protein intake is usually not calculated. Therefore, little is known if these recommendations are followed. Lower carbohydrate intake is reported to be associated with better metabolic control, but data in children are limited.

Aim: This study aimed to assess daily intake of carbohydrates, fat and protein of children and adolescents with type 1 diabetes (T1D) and to compare the results with current nutritional guidelines. Furthermore, an association of macronutrient intake with metabolic control was studied.

Patients and methods: Children aged 7 to 18 years with T1D for > 6 months were recruited into a 14 day observational study. All study participants used continuous glucose monitoring (CGM) and documented meals by taking pictures with a smartphone application using image-based nutrition analysis to quantify meal macronutrient content while continuing their usual eating habits. HbA1c and demographics were collected during a routine visit preceding the study. Percentage time spent in range (TIR) was calculated from CGM data. Carbohydrate, fat and protein intake was calculated and correlated to HbA1c and TIR.

Results: 20 children (10 female, mean age 12.3 (range 7.6-18.5) years) with a mean HbA1c of 7.4% (range 6.1-9.1) and TIR of 58% (range 23-87) participated in the study.

Dietary analysis and recommendations are shown in the table below:

Carbohydrate intake showed a weak correlation to HbA1c (r= -0.5) and TIR (r= 0.5), which was not found for the intake of fat (r= -0.2 and 0.3) or protein (r= -0.1 and 0.05).

Conclusion: In view of current guidelines, meal analysis revealed for children a lower carbohydrate intake, while fat and protein intake approximately correspond to recommendations. In adolescents, the amounts of carbohydrates, fat and protein were lower then recommended. The use of macronutrient calculation via smart-phone application may offer the possibility of integration into more targeted insulin dosing in future. In contrast to studies in adults, lower carbohydrate intake was not associated with better metabolic control.