Diabetes: Type 1 (Pediatrics)

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Diabetes: Type 1 (Pediatrics)

Welcome to the Diabetes Type 1 Pediatric Project

For children and adolescents with type 1 diabetes (T1DM), nutrition is of heightened importance due to the direct association between macronutrient intake and blood glucose levels.1 In looking at T1DM disease management across the lifespan, adolescents consistently demonstrate the poorest glycemic outcomes, followed by children.2 Intervening during adolescence is important for establishing lifelong healthy habits and behaviors with an overarching objective of enhancing overall quality of life and longevity, reducing incidence of disordered eating and long-term complications such as cardiovascular disease.3-5 Therefore, nutrition interventions aiming to improve glycemic management among children and adolescents with T1DM are a priority to improve short- and long-term health outcomes among this vulnerable population.6 

Evidence-Based Nutrition Practice Guideline 

The objective of this evidence-based nutrition practice guideline is to provide evidence-based recommendations for dietitians providing medical nutrition therapy interventions (MNT) for children and adolescents (ages 6–19 years) living with type 1 diabetes. The expert panel focused on the subtopics of:

  • Dietary patterns
  • Carbohydrate management
  • Diet quality 
  • Food insecurity 
  • Culturally relevant/responsive nutrition 
  • Vitamin D supplementation 
  • Medical nutrition therapy
  • Macronutrient consumption

Use the links on the left navigation bar to access the EBNPG. The entire guideline can be downloaded in PDF format from here.

Systematic Review 

The aim of the systematic review was to examine the effectiveness of nutrition management interventions on AIC in children and adolescents (6-19 years) living with T1DM. The expert panel focused on the subtopics of dietary patterns, carbohydrate management, diet quality, food insecurity, culturally relevant/responsive nutrition, vitamin D supplementation, medical nutrition therapy, and macronutrient consumption. 

Key Findings: 

Overall, there was limited available evidence for most of the topics listed above.

  • Limited evidence reports that weekly medical nutrition therapy sessions for the first month after diagnosis and monthly sessions thereafter may reduce A1C. 
  • Very low-quality evidence indicates that improvements in diet quality (HEI score) may be associated with better glycemic outcomes. 
  • The effects of dietary patterns like Mediterranean, DASH, and low glycemic index on glycemic outcomes are inconclusive. 
  • Carbohydrate counting can be an effective strategy to help reduce and provide continued maintenance of A1C goals.  
  • Very low-quality evidence indicates that culturally relevant/responsive nutrition intervention increases the ability to achieve improvements in A1C target and the occurrence of adverse events. 
  • Very low-quality evidence indicates low socioeconomic status and lower maternal education are associated with poor glycemic outcomes and increased occurrence of adverse events, such as diabetic ketoacidosis, hospitalization, and emergency room calls and visits.

Use the links on the left navigation bar to access the results of the systematic review.

Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures, and project funding information. Expand the section titled Resources for information on implementing this guideline in your practice.

References:

  1. Holesh JE AS, Martin A. Physiology, Carbohydrates. Treasure Island (FL). In: StatPearls [Internet]. 2023. PMID: 29083823
  2. Franz MJ. Protein: metabolism and effect on blood glucose levels. Diabetes Educ. 1997;23(6):643-646, 648, 650-641. PMID: 9416027
  3. Association. AD. 13. Children and Adolescents: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S163-s182. PMID: 31862756
  4. Araia E, King RM, Pouwer F, Speight J, Hendrieckx C. Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia. Pediatr Diabetes. 2020;21(4):664-672. PMID: 32134539
  5. Nansel TR, Haynie DL, Lipsky LM, Laffel LM, Mehta SN. Multiple indicators of poor diet quality in children and adolescents with type 1 diabetes are associated with higher body mass index percentile but not glycemic control. J Acad Nutr Diet. 2012;112(11):1728-1735. PMID: 23102173
  6. Spinks J, Guest S. Dietary Management of Children with type 1 diabetes. Pediatrics and Child Health. 2017;27(4):176-180. ISSN/ISBN: 1751-7222

12/18/2024

 

  • Scoping Review Project Team and Disclosures (2019)

    The following individuals contributed their valuable time and expertise to the Diabetes Type 1 Pediatrics Scoping Review:

    Project Team

    • Deepa Handu, PhD, RDN, Project Manager and Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Megan Piotrowski, MS, RN, Lead Analyst
      Shriners Hospital for Children,, Cincinnati, OH, USA


    Content Advisors

    • Erin Phillips, MPH, RDN, CDE
      Erin Phillips Nutrition, LLC, Seattle, WA, USA
    • Amy Poelker, MS, RD, CDE
      Dietitian Diabetes Educator, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA


    Financial Contributors

    • Diabetes Dietetic Practice Group
    • Academy of Nutrition and Dietetics Foundation
    • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members and content advisors have with companies that sell products or services that are relevant to this topic. Workgroup members and content advisors are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have adverse impact on the content, but they are noted here to fully inform readers:

    • None of the content advisors listed above disclosed potential conflicts.

     

     

     

  • Resources

    The following resources have been developed to assist with dissemination and implementation of the T1DM guideline:

    • Type 1 Diabetes Pediatrics (2024) Guideline Presentation - includes all the recommendations and ratings of the EBNPG in a PowerPoint presentation format. Ideal for in-service presentations, staff training sessions and classes (not designed for patient or client use). Download for free.  
    • The Academy's Council on Research Implementation Subcommittee developed Implementing Evidence: from Guidelines to Daily Practice to assist nutrition and dietetics practitioners with implementing evidence-based practice recommendations and clinical practice innovations into daily practice. (PDF). 
    • Practitioner Guide: Guideline Flowchart (PDF). 
    • Practioner Guide: T1DM Medical Nutrition Therapy Recommendations (PDF). 
    • Please see the “Considerations for Application” section of the guideline recommendations for tools and expert advice regarding how to implement the recommendations. 
  • Systematic Review and Guideline Project Team and Disclosures (2022-24)

    Type 1 Diabetes Mellitus (Pediatrics)
    Project Team and Disclosures

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Becky Sulik, RDN, LD, CDCES, Chair 
      Director of Education, Rocky Mountain Diabetes Center, Idaho Falls, ID, USA
    • Catherine Rogers McManus, PhD, RDN, LD, Vice-Chair
      Assistant Professor, Case Western Reserve University, Cleveland, OH, USA
    • Stefanie Leniszewski, MS, RDN, CD, CDCES
      Clinical Diabetes Specialist, Tandem Diabetes Care, Duvall, WA, USA
    • Kasey M. Metz, MS, RDN, LD, CDCES
      Clinical Dietitian, Dayton Children’s Hospital, Dayton, OH, USA
    • Ariela B. Nielson, MS, RD, CDCES
      Founder and Diabetes Educator, Nielson Nutrition & Diabetes Care, Portland, OR, USA
    • Meg Salvia, MS, RDN, CDC, CEDRD-S
      Owner, Meg Salvia Nutrition, Cambridge, MA, USA

    Project Leaders

    • Deepa Handu, PhD, RD, Project Manager and Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Erica K. Gradwell, MS, RD, Lead Analyst 
      Consultant Dietitian, Arvada, Colorado, USA
    • Amanda Wanner, MLS, AHIP, Information Specialist
      Consultant, Saint John, NB, Canada

    Evidence Analysts

    • Lyanne Chin, PhD, RD, Garden, CA, USA
    • Kay Howarter, MS, RD, West Lafayette, IN, USA
    • Amy Huang, Basel, Switzerland
    • Telma Moreira, MS, RD, CSO, CNSC, Houston, TX, USA
    • Megan Piotrowski, MS, BSN, RN, CHES, Grosse Point Farms, MI, USA
    • Helen Solomon, MBA, RD, Wilwood, MO, USA
    • Jinyu Xu, MPH, RD, Columbus, OH, USA

    Guideline Reviewers

    • Danielle L. Brooks, RDN-AP, LD, CDCES
      Registered Clinical Dietitian, Dayton Children’s Hospital, Dayton, OH, USA  
    • Carla E. Cox, PhD, RDN, CDCES, CPT
      Diabetes Care and Education Specialist, Mountain Vista Medicine Pediatric and Young Adult Endocrinology, S Jordan, UT, USA    
    • Heather J. Fortin, RD, CD, CDCES
      Clinical Dietitian Specialist, Children’s Wisconsin, Waukesha, WI, USA  
    • Barbara J. Moulton, RD, LD, CDCES
      Rocky Mountain Diabetes Center, Idaho Falls, ID, USA  
    • Megan Robinson, MS, RD, CDCES, CSSD, LDN
      Advanced Clinical Dietitian, The Children’s Hospital of Philadelphia, Paoli, PA, USA   
    • Allison J. Thirion Blasius, MPH, RD, LD, FAND
      Clinical Dietitian, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
       

    Financial Contributors

    • Academy of Nutrition and Dietetics
    • Academy of Nutrition and Dietetics Foundation
    • Diabetes Care and Education Dietetic Practice Group 

    The views or interests of the funding bodies did not influence the development of the systematic review or evidenced-based nutrition practice guideline.

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Sulik: received chair stipend for serving on the Certification Board for Diabetes Care & Education; received compensation from Military Families Learning Network, Alaska Native Hospital, and JDRF PEAK programs for a total of 7 presentations; received travel and meeting expense reimbursement for Certification Board for Diabetes Care & Education; fees paid for training patients/clients on insulin pumps for Insulet Corporation, Medtronic Diabetes, and Tandem Diabetes.
    • McManus: PI/Co-PI on a grant funded by the American Diabetes Association; Case Western Reserve University School of Medicine.

    updated 12/2024