October 04, 2004

ABSTRACT

Buccino, J., Murray, K., Farmer, S., Assor, E., and Daneman, D.

Canadian Journal of Diabetes, September 2004; 28(3):219-225

The traditional cornerstones of the management of type 1 diabetes mellitus in children and adolescents include insulin, self-monitoring of blood glucose (SMBG) and nutrition therapy (meal planning). However, best practices in each of these areas remain controversial. The purpose of this paper was to systematically review the literature pertaining to the dietary management of type 1 diabetes in children and adolescents to assess the available data and to help inform future research in this area.

Specifically, we reviewed data regarding the different dietary regimens, the glycemic index (GI) and the use of sucrose in children with type 1 diabetes. The evidence strongly suggests that adherence to nutrition therapy is poor unless patients are highly motivated. Some studies showed no difference in metabolic control with the use of strict dietary regimens, while others have shown the importance of maintaining consistency in carbohydrate intake. The GI has demonstrated food predictability in the context of a mixed meal; however, there is a need for further long-term studies in the pediatric populations. Finally, sucrose in isocaloric substitution for starch does not negatively affect glycemic control.

We conclude that our understanding of best practice in nutrition therapy for children and teens with type 1 diabetes remains rudimentary, and that concerted research efforts are warranted to fill the considerable gaps in knowledge.

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