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The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on p...

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Autores principales: Furthner, Dieter, Lukas, Andreas, Schneider, Anna Maria, Mörwald, Katharina, Maruszczak, Katharina, Gombos, Petra, Gomahr, Julian, Steigleder-Schweiger, Claudia, Weghuber, Daniel, Pixner, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537759/
https://www.ncbi.nlm.nih.gov/pubmed/34684559
http://dx.doi.org/10.3390/nu13103558
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author Furthner, Dieter
Lukas, Andreas
Schneider, Anna Maria
Mörwald, Katharina
Maruszczak, Katharina
Gombos, Petra
Gomahr, Julian
Steigleder-Schweiger, Claudia
Weghuber, Daniel
Pixner, Thomas
author_facet Furthner, Dieter
Lukas, Andreas
Schneider, Anna Maria
Mörwald, Katharina
Maruszczak, Katharina
Gombos, Petra
Gomahr, Julian
Steigleder-Schweiger, Claudia
Weghuber, Daniel
Pixner, Thomas
author_sort Furthner, Dieter
collection PubMed
description Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.
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spelling pubmed-85377592021-10-24 The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps Furthner, Dieter Lukas, Andreas Schneider, Anna Maria Mörwald, Katharina Maruszczak, Katharina Gombos, Petra Gomahr, Julian Steigleder-Schweiger, Claudia Weghuber, Daniel Pixner, Thomas Nutrients Systematic Review Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary. MDPI 2021-10-11 /pmc/articles/PMC8537759/ /pubmed/34684559 http://dx.doi.org/10.3390/nu13103558 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Furthner, Dieter
Lukas, Andreas
Schneider, Anna Maria
Mörwald, Katharina
Maruszczak, Katharina
Gombos, Petra
Gomahr, Julian
Steigleder-Schweiger, Claudia
Weghuber, Daniel
Pixner, Thomas
The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title_full The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title_fullStr The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title_full_unstemmed The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title_short The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps
title_sort role of protein and fat intake on insulin therapy in glycaemic control of paediatric type 1 diabetes: a systematic review and research gaps
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537759/
https://www.ncbi.nlm.nih.gov/pubmed/34684559
http://dx.doi.org/10.3390/nu13103558
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