Addressing clinical challenges in the management of paediatric type 1 diabetes

<p dir="ltr">Background: The 3 pillars of paediatric T1D management are insulin therapy, nutrition and physical activity. Despite advances in understanding and management of T1D, the majority of people do not meet glycaemic targets set to minimise the risk of diabetes related complications.</p><p dir="ltr">Factors considered to be influences on glycaemic outcomes were identified including carbohydrate intake, meal structure, dietary quality, levels of daily physical activity, exercise type, automated insulin delivery systems (AID) during exercise and children under 7yo living with T1D.</p><p dir="ltr">Methods: Four studies were performed; 1. A narrative review of low carbohydrate diets in T1D, 2. A retrospective observational study of dietary intake and mealtime characteristics of young children with T1D meeting glycaemic targets, 3. A prospective observational study that measured physical activity and assessed barriers in young children with T1D, and 4. A randomised crossover trial assessing glycaemic impact of exercise type in adolescents with T1D using AID.</p><p dir="ltr">Results: The studies found: 1. There was insufficient evidence of efficacy for the use of low carbohydrate diets in T1D and they may impact nutrition and growth; 2. Young children with T1D have diets high in saturated fat and having structure to mealtimes was associated with better glycaemic control; 3. Young children with T1D do not meet moderate to vigorous physical activity recommendations similar to their general population peers and T1D was not reported to be a major barrier to physical activity in this age group; and 4. There were differences in glycaemia following distinct exercise types when using AID and identified that extra carbohydrate and changes to insulin dosing following exercise is needed.</p><p dir="ltr">Conclusions: This thesis contributes to the evidence base to guide clinical practice in management of paediatric T1D. We identified that glycaemic targets can be achieved with appropriate diet quality/quantity/structure. We demonstrated that T1D is not a barrier to physical activity in young children and activity should be encouraged. We described the impact of different types of exercise on glycaemic profile and used this to develop strategies to manage exercise with AID.</p>