title: Nutritional management of children and adolescents on insulin pump therapy - a survey of Australian Practice.
abstract: OBJECTIVE
  The aims of the survey were to review nutritional care provided to children on insulin pump therapy (IPT) and to identify areas of consensus in medical nutrition therapy. Interventions were compared with existing evidence for best practice.
  
  
  METHODS
  A questionnaire was sent to Dieticians in tertiary pediatric diabetes centers in Australia. Data were gathered on clinic demographics, reasons for commencement of pump therapy, and time spent in medical nutrition therapy. Details of nutrition education strategies were identified. Outcomes from nutrition interventions were reported.
  
  
  RESULTS
  A 100% response rate was achieved (n = 12). A number of nutrition therapy interventions were provided to children on IPT. These included carbohydrate counting, glycemic index (GI), and carbohydrate exchanges. At most centers, nutrition education involved teaching dose adjustment for meals based on the carbohydrate content of the meal with estimations to within 5 g. All centers taught GI. The format of nutrition education, including number and length of consults, varied greatly between centers. Only one center had developed nutrition guidelines for managing insulin pump patients.
  
  
  CONCLUSIONS
  Most pediatric diabetes centers in Australia did not follow nutrition guidelines for the management of children on IPT. There were inconsistencies in the number and length of nutrition consultations provided. Some strategies employed in nutrition education were not supported by existing guidelines for best practice. Differences between centers highlighted gaps in the evidence for nutrition therapy interventions in children on pumps.
authors.affiliation: John Hunter Children's Hospital, Newcastle, NSW, Australia. carmel.smart@hnehealth.nsw.gov.au
authors.forename: Carmel E
authors.initials: CE
authors.lastname: Smart
authors.forename: Clare E
authors.initials: CE
authors.lastname: Collins
authors.forename: Julia
authors.initials: J
authors.lastname: Schoonbeek
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000503:physiopathology*; D006306:Health Surveys; D006801:Humans; D007332:Insulin Infusion Systems; D015596:Nutrition Assessment; D011795:Surveys and Questionnaires