Families' reports of problematic foods, management strategies and continuous glucose monitoring in type 1 diabetes: A cross-sectional study.

Aims: To identify foods that cause problematic postprandial blood glucose levels (BGLs) in children and young people with type 1 diabetes, the strategies families use to manage these foods and the impact of continuous glucose monitoring (CGM) on nutritional management.

Methods: This was a cross-sectional survey of 100 families attending a paediatric diabetes centre in Australia.

Results: Participants (n = 100) had a mean age of 13.0 ± 3.6 years; diabetes duration 5.2 ± 4.0 years; HbA1c 53 ± 0.9 mmol/mol (7.0 ± 0.8%); 52% used multiple daily injections (MDI, ≥4 injections/day); 48% used insulin pump therapy; and overall, 60% used CGM. Ninety-one participants (91%) identified problematic foods, including pizza (60%), pasta (55%) and rice (31%). Of these, 96% used one or more strategies to manage BGLs, including correcting BGLs more often (51%), use of a combination bolus (39%) and increasing the meal insulin dose (32%). Participants who gave additional meal insulin (n = 28) increased the dose by 10% to 25%. All MDI users (n = 15) gave additional insulin pre-prandially. Of those using CGM, 88% (n = 53) reported an increased awareness of the glycaemic impact of foods, and 27% (n = 16) had subsequently made changes to their management including avoiding and/or restricting new foods (n = 7).

Conclusions: Families with type 1 diabetes reported foods such as pizza, pasta and rice as problematic and used strategies such as increasing the insulin dose to minimise their glycaemic impact. CGM contributed to the awareness of problematic foods. Clinicians should discuss these foods and, if challenging, provide targeted strategies including adjusting the insulin dose and delivery pattern to improve postprandial glycaemia.