T1DM: Executive Summary of Recommendations (2024)
Executive Summary of Recommendations
Below are the recommendations and ratings for the Academy of Nutrition and Dietetics Type 1 Diabetes Mellitus (T1DM) 2023 Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Guideline Recommendations and Supporting Evidence tab.
Each recommendation was developed from specific systematic review questions. Please download the "Relationship between PICO Questions and Recommendations" table (PDF) for details.
- For a description of the Academy Recommendation Rating scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
- For a description of the GRADE Recommendation Rate scheme (Level 1 (1A, 1B, 1C, 1D), Level 2 (2A, 2B, 2C, 2D), click here
-
Screening and Referral
T1DM: Vitamin D Deficiency Screening
In children and adolescents, we suggest screening for vitamin D deficiency at stage I type 1 diabetes (>=2 type 1 diabetes associated islet autoantibodies) or first onset of type 1 diabetes symptoms.
T1DM: Screening for Associated Factors
It is reasonable that health care professionals screen for disordered eating behaviors, food insecurity, housing stability/homelessness, health literacy, financial barriers, and social/community support and apply that information to treatment decisions.
-
Nutrition Assessment
T1DM: Nutrition Assessment
In children and adolescents newly diagnosed with type 1 diabetes, it is reasonable for a registered dietitian nutritionist or international equivalent to complete a thorough nutrition and diabetes education assessment that also considers:
- Review and assess data from regular screenings for glycemic labs, lipid abnormalities, blood pressure, and celiac disease per American Diabetes Association Standards of Care.
- Current type 1 diabetes knowledge, skills, competency of required diabetes management.
- Readiness to change of child/adolescents and their care partners.
- Barriers to learning.
- Access to diabetes management tools/resources and medications.
- Psychosocial needs/barriers, including social support, financial resources.
- Disordered eating behaviors.
- Client/family input on glycemic targets.
-
Nutrition Intervention
T1DM: Medical Nutrition Therapy
Medical nutrition therapy provided by a registered dietitian nutritionist or international equivalent is recommended for children and adolescents living with type 1 diabetes to manage A1C, as appropriate and desired by each client.
T1DM: Medical Nutrition Therapy-Initial Encounters
In children and adolescents living with type 1 diabetes, it is reasonable for a registered dietitian nutritionist or an international equivalent to collaborate with individuals with type 1 diabetes, their families, and interdisciplinary healthcare teams to design individualized medical nutrition therapy based upon the individual’s diabetes treatment plan, overall health and nutritional status, personal preferences, psychological and psychosocial factors, and physiological needs. Medical nutrition therapy for individuals with type 1 diabetes should focus on comprehensive nutrition assessment that includes considerations for insulin planning/administration, reducing short-term adverse events (hyperglycemia, hypoglycemia) and appropriate interventions, including individualized modification of diet, to maintain or improve nutrition status, and monitoring over time.
T1DM: Diet Quality
In children and adolescents living with type 1 diabetes, we suggest having a registered dietitian nutritionist or an international equivalent provide individualized nutrition education that includes discussion on diet quality to manage glycemia.
T1DM: Carbohydrate Management Strategies
In children and adolescents living with type 1 diabetes, a registered dietitian nutritionists or international equivalent should suggest carbohydrate counting or carbohydrate estimation as a strategy to effectively dose insulin to optimize glycemic management.
T1DM: Individualize Macronutrient Composition
It is reasonable for a registered dietitian nutritionist or international equivalents, in collaboration with youth living with type 1 diabetes and their families to individualize the macronutrient composition of a healthy, energy appropriate eating plan to optimize glycemic outcomes.
T1DM: Dietary Patterns
For all children and adolescents living with type 1 diabetes, it is reasonable for the registered dietitian nutritionist or international equivalent to consider advising a dietary pattern, individualized for dietary preferences, nutrient needs, and available resources that promotes consumption of nutrient-dense foods.
T1DM: Vitamin D
In children and adolescents living with type 1 diabetes, we suggest prescribing Vitamin D supplementation in the form of cholecalciferol or ergocalciferol to correct 25(OH)D deficiency/insufficiency.
T1DM: Culturally Relevant/Responsive Nutrition Interventions
The registered dietitian nutritionist or international equivalent should work in collaboration with children and adolescents with type 1 diabetes and their family to develop an individualized developmentally appropriate nutrition prescription plan that is tailored to each clients personal preferences (eg, tradition, culture, religion, health beliefs and goals), available resources (eg, food retailers, transportation, culinary/kitchen equipment, time), stage of behavior change, and a variety of eating patterns (different foods or food groups) to help optimize glycemic management.
T1DM: Food Insecurity
It is reasonable for healthcare professionals to screen for food insecurity, housing stability/homelessness, health literacy, financial barriers, and social/community support and apply that information to treatment decisions.
-
Nutrition Monitoring and Evaluation
T1DM: Effectiveness of Medical Nutrition Therapy
In children and adolescents living with type 1 diabetes, it is reasonable for a registered dietitian nutritionist or international equivalent to assess/reassess the following areas during follow-up interventions/visits:
- Diabetes-focused reassessment of dietary intake, nutrient needs, nutrition and/or carbohydrate management.
- Growth trajectory of the child/adolescent relative to their personal growth history and the typical growth of other children/adolescents of the same age and sex.
- Knowledge, skills, competencies of diabetes management tasks and need for additional training and education.
- Progress on behavioral goals.
- Monitor blood glucose and insulin dosing data to help optimize both food intake and related insulin dosing and timing with meals.
- Readiness in a client’s ability to perform diabetes self-management tasks, particularly in an adolescent transition to self-care.
- Effectiveness of strategies to address learning barriers and readiness to change.
- Disordered eating behaviors.
- Psychosocial needs or barriers.
- Diabetes distress and depression.
T1DM: Medical Nutrition Therapy Follow-Up Encounters
The registered dietitian nutritionist or international equivalent should implement additional encounters to help children and adolescents and support persons adjust nutrition planning in concert with the changes and adjustments to insulin therapy until consistent goals are met (eg, blood glucose levels, time in range, A1C). More visits are likely to be needed in the first 6–12 months following diagnosis of type 1 diabetes. A minimum of one annual medical nutrition therapy follow-up encounter is needed. With growth and development, nutrition and insulin need to change frequently, so more encounters may be needed if diabetes care goals are not met.
