Endocrine Abstracts

Introduction: The International Society for Paediatric and Adolescent Diabetes (ISPAD) 2022 Nutritional Guidelines recommend calculating carbohydrate requirements using an indivualised equation, such as the Schofield equation. Up to 2023, our centre used the Scientific Advisory Committee on Nutrition (SACN) 2011 guidelines that only require age to determine average carbohydrate requirements. The latest National Paediatric Diabetes Audit (NPDA) showed our centre to have 16.7% overweight and 28.5% obese CYPD, which is above the national average. Therefore, using ideal body weight (IBW) rather than actual body weight must be considered when calculating requirements.

Aim: To retrospectively compare the SACN carbohydrate requirements prescribed with individualised carbohydrate requirements calculated using the Schofield equation for newly diagnosed children and young people with type 1 diabetes (CYPD) at our centre.

Methods: Retrospective data analysis collected on newly diagnosed CYPD from January 2022 to December 2022. Anthropometric data [height, weight, age, Body Mass Index (BMI) centile] collected at diagnosis were obtained from our online diabetes management database (TWINKLE). SACN carbohydrate requirements were calculated by (1) Average energy requirements for age via SACN (2) 45% of energy from carbohydrates (3) divided by four to get grams (g) of carbohydrates. Schofield carbohydrate requirements were calculated by (1) Gender-specific Scofield equation to get energy requirement using IBW [BMI at the 50th percentile for age*(height in meter2)] with an activity factor of 1.5, steps (2) and (3) as above. Results are presented as mean (standard deviation) and mean comparisons using T-Test (two-tailed, P<0.05).

Results: There were 27 newly diagnosed CYPD with an average age of 9.6 (4.2SD) years, BMI of 19.2 (4.9SD) kg/m2, 67th centile, 44% being female. The average carbohydrate requirements using SACN and Schofield were, 257 (96.9SD) g and 185 (42.7SD) g, respectively. The SACN calculation suggesting 72 (72.9SD) g (P<0.001) more than the Schofield.

Conclusion: CYPD require an individualised carbohydrate prescription that uses height, weight, ideal body weight, and activity factor to prevent overprescribing carbohydrate. Our results support the ISPAD 2022 nutrition guidelines, and our practice has changed to tackle the high level of obesity in our cohort. Further audit will assess the impact of this change.