ESPE Abstracts

Background: Despite the increasing incidence of type 2 diabetes mellitus (T2DM) in Children and Young People (CYP), and its associated morbidities and poor long-term prognosis, there remains uncertainty in its management. Dietary interventions have been shown to be effective in adults with T2DM but little is known about their effectiveness in CYP. The aim of this systematic review is to provide up to date evidence on the impact of dietary interventions in T2DM in childhood and adolescence.

Methods: Five databases Embase, MEDLINE, CENTRAL, Web of Science and CINAHL were searched from January 2000 to May 2023 for studies involving dietary interventions in CYP under 19 years with T2DM. All study types were included. The primary outcome was glycaemic control measured by glycated haemoglobin (HbA1C). Secondary outcomes included adherence to intervention, adverse events, body mass index (BMI) change, and changes to pharmacological treatment. Two authors independently screened papers (with 10% reviewer crossover), extracted data from eligible studies and assessed risk of bias using ROBINS-I and ROBINS-E.

Results: Of the 8352 search results, 250 underwent full text screening. Five papers met the inclusion criteria. Two studies were interventional, three were observational, no randomised controlled trials were identified. In the two interventional studies, with 28 participants combined, a Very Low Energy Diet/Very Low Calorie Diet (VLED/VLCD) was associated with reduced HbA1c (median 16mmol/mol reduction after 8 weeks), decreased requirement for pharmacological treatment and improved weight loss. However, benefits to HbA1c were not sustained over 2 years. In the observational studies, with 917 participants combined, the most popular self-reported dietary strategies used were limiting sweets and increasing fruit and vegetable intake, but efficacy was limited or absent. Limiting high fat foods/saturated fat was associated with improved HbA1c, although the effects were small.

Discussion: This systematic review demonstrates that there is currently limited evidence and a lack of robust clinical trials to support the effectiveness of dietary interventions in the management of CYP-onset T2DM. With evidence of benefit in adulthood and encouraging short-term results from initial studies in the young, it is imperative that fully powered randomised trials with longer follow up are undertaken to determine long-term efficacy of dietary interventions in CYP. With rapidly increasing incidence combined with early onset of complications conferring poor long-term prognosis, it is paramount that new management options for T2DM in CYP are urgently investigated.