During a Monday morning symposium at the Scientific Sessions, a panel of pediatric diabetes experts discussed the challenges parents and providers face when trying to manage the dietary and nutritional needs of children with type 1 diabetes.
Nana-Hawa Yayah Jones, MD, Assistant Professor in the Division of Endocrinology at Cincinnati Children’s Hospital Medical Center, addressed the challenges of continuous glucose monitoring and the benefits of continuous subcutaneous insulin infusions (CSII) versus multiple daily injections (MDI) in young children.
“Randomized controlled trials comparing CSII and MDI demonstrate a modest improvement in A1C in participants on CSII. Observational studies, registry data, and meta-analysis have also suggested an improvement of glycemic control in participants on CSII,” Dr. Jones said. “Although hypoglycemia was a major adverse effect of intensified insulin regimen in the Diabetes Control and Complications Trial, data suggest that CSII may reduce the rates of severe hypoglycemia compared with MDI.”
Carmel E. Smart, RD, PhD, Senior Diabetes Dietitian and Clinical Research Fellow at the John Hunter Children’s Hospital in Newcastle, Australia, discussed the unique nutritional challenges for families of young children with diabetes, including observations from her clinical practice and translational research.
“It is common for all parents of preschoolers to worry about how much their child is eating, and all the more challenging in the context of a preschooler with type 1 diabetes,” Dr. Smart said. “Common food challenges include unpredictable appetite, transient food preferences, and food refusal.”
Dr. Smart and her colleagues recently conducted a study about the dietary intake and eating patterns of children younger than 7 years of age and found that A1C was significantly higher in children offered food in a grazing pattern compared to those offered regular meals.
“We found that 95 percent of parents routinely gave insulin either 15 minutes or immediately before eating, even though, as expected in this age group, 73 percent reported that their child refused food at times,” Dr. Smart said. “Also of concern, we found that the dietary quality of these preschool children was suboptimal, with just over half of the children meeting the recommended number of servings for fruit, and none meeting their vegetable recommendations. Saturated fat was also excessive.”
Strategies to encourage healthier eating habits, she said, include repeated exposure to new foods, offering small amounts initially to familiarize the child alongside their more commonly eaten foods.
Mark A. Clements, MD, PhD, CPI, a pediatric endocrinologist at Children’s Mercy Hospital, offered additional mealtime strategies to help parents guide their young children in developing optimal nutritional habits to control their diabetes.
“Parents of young children with type 1 diabetes perceive mealtime as most problematic for diabetes care and report more problems than parents of youth without type 1 diabetes,” Dr. Clements said. “Among the strategies we recommend for parents are adhering to a schedule for meals and snacks, having family sit-down meals at a specified place, and limiting distractions at meals.”
Jessica Pierce, PhD, a psychologist at Nemours Children’s Hospital and the University of Central Florida College of Medicine, described a unique, crowdsourced coping intervention designed to support parents of young children with type 1 diabetes.
“As part of a four-year study, we set out to design, build, and test a stakeholder-driven, user-centered online coping resource to meet the unique needs of parents of young children with type 1 diabetes,” Dr. Pierce said. “In addition to feature content authored by both parents and providers, the website includes links to diabetes-related news articles, a discussion board, and a photo gallery for parents to share pictures. We are currently in the randomized controlled trial phase of the study, comparing parents randomized to usual care versus usual care plus access to the website on a number of parent and child factors.”