Dietary Changes and Gut Dysbiosis in Children With Type 1 Diabetes

Objective: Gut dysbiosis in type 1 diabetes (T1D), characterized by high Bacteroides proportion, tends to reverse as T1D progresses, without reaching full recovery. Since diet influences microbiota structure, the aim was to evaluate the impact of dietary changes on Bacteroides proportion the first year of T1D evolution.

Methods: Dietary intake was assessed by 24-hour recalls and Bacteroides proportion by quantitative polymerase chain reaction, in 10 Mexican children (11.6 ± 1.92 years) with T1D at baseline and 3, 6 and 9 months' follow-up. Repeated measures analysis of variance and multiple linear regression were performed to compare ingested nutrients in relation with Bacteroides proportion. Effects over time were evaluated by mixed regression models.

Results: Patients with T1D decreased their energy (2621.89 to 1867.85 kcal, p = 0.028), protein (83.06 to 75.17 g, p = 0.012), and saturated fat consumption (40.83 to 25.23 g, p = 0.031) from baseline to 3 months, without posterior changes. Bacteroides proportion increased in the first months and tended to decrease at around 9 months (p > 0.05) and was positively correlated with saturated fat (β = 3.70, p = 0.009) and total carbohydrates (β = 0.73, p = 0.005) at 3 months. Carbohydrate consumption was related to decreased Bacteroides abundance over time (β = ?14.9, p = 0.004), after adjusting for glycosylated hemoglobin.

Conclusions: Besides autoimmunity, diet appears to have a central role determining the T1D-associated dysbiosis evolution.     

哈尔滨市儿童1型糖尿病危险因素研究

在对哈尔滨市１５岁以下Ｉ型糖尿病患者进行登记的基础上,为寻找发病的环境危险因素,采用１：２的病例对照研究方法,调查了５０例儿童糖尿病患者和１００例对照。经单因素分析发现易患呼吸道感染和肠道感染、有既往麻疹和水痘病史、婴儿期（１￣３个月）接触牛奶、易发热、易受惊吓以及Ｉ型糖尿病家族史均能增加发病危险。经多因素Ｌｏｇｉｓｔｉｃ回归模型分析,筛选出易患呼吸道感染和肠道感染、既往患床疹及易受惊吓为引起儿童     

Rethinking Carbohydrate Intake and Time in Range in Children and Adolescents with Type 1 Diabetes

The aim of this study was to evaluate the association between macronutrient intake and time in range (TIR) of 70–180 mg/dL in children and adolescents with type 1 diabetes (T1D). A multi-center study recruited patients with T1D using continuous glucose monitoring (CGM) between January 2019 and January 2020 from centers across Italy. Diet intake was recorded using three-day weighed food diaries. Nutrients were evaluated as percentages of total intake. TIR was considered at target if the percentage of readings was higher than 70%. Clinical and nutritional factors associated with TIR at target were analyzed using multiple correspondence analysis and multiple logistic regression. Data from 197 participants (53% male, median age 11.6 years, median HbA1c 55.2 mmol/mol, median TIR 60%) were analyzed. Macronutrient intake was 45.9% carbohydrates, 16.9% protein, 37.3% fat, and 13.1 g/day fiber (median values). TIR > 70% was observed in 28% of participants; their diet contained more protein (17.6%, p = 0.015) and fiber (14.4 g/day, p = 0.031) than those not at target. The probability of having a TIR > 70% was significantly higher with 40–44% consumption of carbohydrates compared with 45–50% consumption of carbohydrates and with the use of a carbohydrate counting system. Based on these results, a five percent reduction in the percentage of carbohydrate intake can help children and adolescents with T1D achieve the goal of a TIR > 70%. Both a lower and higher percentage of carbohydrate intake appears to reduce the probability of reaching the target TIR > 70%. These results require validation in other populations before being used in clinical practice.     

Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus

Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297–700) vs. 328 (167–447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13–48) vs. 34 (14–77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D.     

Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study

Aims/hypothesis: The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data. Methods: Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children’s carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment. Results: A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist. Conclusions/interpretation: Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.     

Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes

The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8–15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.     

儿童1型糖尿病病人生存质量影响因素研究

目的；研究儿童1型糖尿病病人的生存质量的影响因素。方法：编制了儿童1型糖水病病人生存质量量表。结果：量表具有较好的信度和效度；量表中满意度领域，影响度领域和担忧度领域与儿童健康状况的自我评价显著相关，儿童1型糖尿病病人的生存质量与控制饮食及胰岛素注射方式相关，而与性别，年龄，病程，每日注射胰岛素次数，每日血糖检测次数等因素无相关关系。     

The Role of Gluten in Celiac Disease and Type 1 Diabetes

Celiac disease (CD) and type 1 diabetes (T1D) are autoimmune conditions in which dietary gluten has been proven or suggested to play a pathogenic role. In CD; gluten is established as the instigator of autoimmunity; the autoimmune process is halted by removing gluten from the diet; which allows for resolution of celiac autoimmune enteropathy and subsequent normalization of serological markers of the disease. However; an analogous causative agent has not yet been identified for T1D. Nevertheless; the role of dietary gluten in development of T1D and the potentially beneficial effect of removing gluten from the diet of patients with T1D are still debated. In this review; we discuss the comorbid occurrence of CD and T1D and explore current evidences for the specific role of gluten in both conditions; specifically focusing on current evidence on the effect of gluten on the immune system and the gut microbiota.     

Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review

Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The purpose of this systematic review is to provide a concise and critical overview of the prevalence of MetS in children and adolescents with T1DM and, ultimately, to discuss prevention and treatment options. The study was conducted in accordance with PRISMA guidelines. This review shows that, apart from the growing percentage of overweight and obese children and adolescents with T1DM (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2 to 29.9%, depending on the criteria used) is one of the most important phenomena of our time. One of the methods of prevention and treatment is a combined approach: changing eating habits and lifestyle, but there are also reports about the beneficial effects of the gut microflora.     

海南省儿童1型糖尿病发病率调查

目的：调查海南儿童１型糖尿病的发病率。方法：依据ＷＨＯ ＤｉａＭｏｎｄ计划,采用捕获一再捕获的方法,对１９８９－１９９６年间１５岁以下新诊断为１型糖尿病的儿童进行回顾性登记。结果：１５岁以下人口总数约２００万,共发现１型糖尿病患者５３例,其中汉族５０例,其他民族３例,按其人口比例计算,二者发病率无显著性差异。     

Time Course of Oxidative Stress Status in the Postprandial and Postabsorptive States in Type 1 Diabetes Mellitus: Relationship to Glucose and Lipid Changes

Objective: The aim of this study was to compare oxidative stress status (OSS) with blood glucose and lipid changes during the fasting, postprandial and postabsorptive phases in type 1 diabetes mellitus.

Methods: Twenty-three patients on intensive insulin treatment received a standard fat-rich breakfast and lunch. OSS was monitored at fasting (F), just after the post-breakfast glycemia peak (BP) (identified by continuous subcutaneous glucose monitoring), 3.5-h post-breakfast (B3.5), just after the post-lunch peak (LP), just after the post-lunch dale (LD) and 5 hours after lunch (L5).

Results: Whereas whole blood glutathione and plasma protein thiols increased in the postprandial period (from 6.52 ± 1.20 (F) to 7.08 ± 1.45 μmol/g Hb (BP), p = 0.005), ascorbate decreased gradually from 44 ± 17 (F) to 39 ± 19 μmol/L (LD), p = 0.015. Retinol and α-tocopherol also decreased from 27.1 ± 7.0 (F) to 25.3 ± 5.2 μmol/L (BP), p = 0.005. Uric acid decreased later, from 213 ± 77 (BP) to 204 ± 68 μmol/L (B3.5), p = 0.01, but then increased in LP (231 ± 70 μmol/L) and LD to values higher than F (215 ± 64, μmol/L, p = 0.01). Malondialdehyde increased gradually from 1.02 ± 0.36 (F) to a maximum of 1.14 ± 0.40 μmol/L (LP). In the postabsorptive phase (L5) all parameters except for thiols reverted to fasting concentrations.

Conclusions: In type 1 diabetes lipid peroxidation increases during the postprandial phase in parallel to glucose and triglyceride changes. Blood antioxidants, however, followed diverse patterns of change.     

Type 1 Diabetes in the Young: Organization of Two National Centers in Israel and Slovenia

Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.     

The Prime Diabetes Model: Novel Methods for Estimating Long-Term Clinical and Cost Outcomes in Type 1 Diabetes Mellitus

Background

Recent publications describing long-term follow-up from landmark trials and diabetes registries represent an opportunity to revisit modeling options in type 1 diabetes mellitus (T1DM).

对128例1型糖尿病患儿的生存质量调查分析

目的：调查分析1型糖尿病患儿的生存质量,以供临床参考。方法：选取本院2010年8月-2013年7月收治的128例1型糖尿病患儿作为研究对象,分别于入院时和实施健康教育1年后采用儿童生存质量测定量表（PedsQL4.0）对其进行生存质量调查。对比实施健康教育前后一年内患儿生存质量的变化。结果：入院时患儿生活质量评分为（78.23±11.65）分,实施健康教育1年后患儿生活质量评分提高至（90.15±6.75）分,差异有统计学意义（P〈0.05）。结论：1型糖尿病患儿的生存质量处于相对较差的水平,实施健康教育可有效提高其生存质量,今后应将健康教育贯穿于药物治疗之中进行临床推广。     

Pilot Study Results for a Novel Behavior Plus Nutrition Intervention for Caregivers of Young Children With Type 1 Diabetes

ObjectiveTo present results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (mean age, 5.0 ± 1.2 years) with type 1 diabetes mellitus (T1DM).MethodsThe researchers recruited 9 caregivers who participated in the 6-session intervention and completed baseline and posttreatment assessments, which included dietary intake, acceptability of diet changes, mealtime behavior, and mean blood glucose values.ResultsChildren's mean daily blood glucose levels decreased from 185 ± 46 mg/dL to 159 ± 40 mg/dL (P < .001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children's dietary intake indicators that could be detected.Conclusions and ImplicationsIt appears promising that this targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with type 1 diabetes mellitus. Larger, randomized controlled trials will clarify significant results, limitations, and sustainability. Techniques within the program may have application to current practice.     

Nut Consumption Is Associated with Lower Risk of Metabolic Syndrome and Its Components in Type 1 Diabetes

Although nut consumption has been associated with several health benefits, it has not been investigated in individuals with type 1 diabetes. Therefore, our aim was to assess nut consumption and its association with metabolic syndrome in adult individuals with type 1 diabetes taking part in the Finnish Diabetic Nephropathy Study. The nut intake of the 1058 participants was assessed from 3-day food records that were completed twice, and the number of weekly servings, assuming a serving size of 28.4 g, was calculated. Metabolic syndrome was defined as the presence of ≥3 of the cardiovascular risk factors: central obesity, high blood pressure (≥130/85 mmHg or use of antihypertensive medication), high triglyceride concentration (≥1.70 mmol/L or use of lipid-lowering medication), low HDL-cholesterol concentration (<1.00 mmol/L in men and <1.30 mmol/L in women or use of lipid-lowering medication), and hyperglycaemia. Overweight/obesity was defined as a BMI ≥25 kg/m². HbA_1c > 59 mmol/mol (>7.5%) was used as a criterion for suboptimal glycaemic control. Of the 1058 (mean age 46 years, 41.6% men) participants, 689 (54.1%) reported no nut intake. In the remaining sample, the median weekly nut intake was 40.8 g. In the adjusted models, higher nut intake, as the continuous number of weekly servings and the comparison of those with <2 and ≥2 weekly servings, was associated with lower metabolic syndrome score, waist circumference, HbA_1c, and BMI. Nut consumption as a continuous variable was negatively associated with the presence of metabolic syndrome, its blood pressure, triglyceride, and HDL-cholesterol components, and suboptimal glycaemic control. Consumption of ≥2 weekly servings was associated with lower odds of suboptimal glycaemic control (by 51.5%), overweight/obesity (by 33.4%), and metabolic syndrome (by 51.8%) and meeting the waist (by 37.3%), blood pressure (by 44.5%), triglyceride (by 37.7%), and HDL-cholesterol (by 36.2%) components of the metabolic syndrome. In conclusion, a weekly nut intake of ≥2 servings was beneficially associated with all the components of the metabolic syndrome in type 1 diabetes. The causality of this association will need to be investigated.     

Correlates of Medical Nutrition Therapy and Cardiovascular Outcomes in Youth With Type 1 Diabetes

ObjectivesTo examine whether the types of medical nutrition therapies (MNTs) taught to and used by youth with type 1 diabetes (T1D) vary by sociodemographic characteristics and cardiovascular (CVD) risk factors.DesignCross-sectional study.SettingThe SEARCH for Diabetes in Youth study is a population-based cohort of individuals with clinical diagnosed diabetes.ParticipantsA total of 1,191 individuals with T1D.Main Outcome MeasuresTypes of MNTs and frequency of use.AnalysisBivariate analysis and multivariate linear regression (P < .05)ResultsMore race/ethnic minorities (vs whites), individuals with parents with less than a high school education (vs high school or higher education), and overweight/obese (vs underweight/normal weight) were taught additional MNTs. For underweight/normal weight individuals exclusively taught carbohydrate counting, those who used this approach “often” had lower hemoglobin A1c (8.6% vs 8.9%) and triglycerides (73.5 vs 84.1 mg/dL) than those who used it “sometimes/never.” “Often” use of additional MNTs beyond carbohydrate counting was not associated with better mean values for CVD risk factors.Conclusions and ImplicationsIn individuals with T1D, race/ethnic minorities, individuals with parents with less than a high school education, and overweight/obese individuals are taught more MNTs. Further research is needed to understand the effectiveness of the various MNTs on CVD risk factors, and to identify how to translate nutrition knowledge to behavior and metabolic status.