Endocrine Abstracts

JOINT138

Background: In resource-limited settings, poor support and non-compliance for school-time insulin, coupled with carbohydrate-rich breakfast and school-snacks, school-time is the most vulnerable period for hyperglycemia. Thus, appropriate nutritional intervention is a practical solution to the aforementioned problem. Medical nutrition therapy (MNT) in type 1 diabetes (T1D) is associated with improved glycemic outcomes. Hence, this study examines the effect of MNT on the glycemic outcomes in school going children with T1D.

Aim: The aim of this open-label randomized controlled trial was to determine the effectiveness of MNT in the form of appropriate carbohydrate and calorie containing breakfast and school-snacks, on the glycemic control during school hours, in children with T1D.

Methods: At the baseline, for a total of 60 children and adolescents with T1D, glycemic parameters were recorded using a continuous glucose monitoring system (CGMS) for 14 days along with the dietary records. In the RCT, the intervention group (n = 30) received carbohydrate content of 45-55% during breakfast and school-snacks whereas, the control group practiced the routine diet, for four weeks and reassessed with CGMS for 14 days with dietary analysis. The CGMS derived glycemic variables for the school-time and the whole day as well, were analyzed along with the dietary analysis for average dietary records, during the 14 days of CGMS. The primary outcome was to determine the difference in the time in range (TIR) between the intervention and control group.

Results: After the dietary modification provided in the intervention group, the carbohydrate content reduced significantly from 59. 9% to 50. 1% (P = 0. 01) in the breakfast, and from 65. 5% to 52. 1% (P = 0. 002) in the mid-morning snacks during the school-hours. The TIR significantly improved (P = 0. 018) whereas, the time above range (TAR) significantly reduced (P = 0. 039), in the intervention group. The TIR showed significant improvement in the 24-hour CGMS profile as well (P = 0. 037). Multivariate regression showed insulin requirement and change in carbohydrate percentage in the midmorning snacks had significant association with TIR. The intervention was safe as there was no significant increase in time below range (TBR) and no episode of severe hypoglycemia was recorded in the intervention group.

Conclusion: An appropriate reduction in carbohydrate content in breakfast and midmorning snacks improves TIR and reduces TAR during school hours in children with T1D who do not administer pre-snack insulin at school, with benefits extending to 24-hour profile. The MNT intervention was very effective in improving the overall glycemic outcomes and was safe as well.