title: A flexible diet using an insulin to carbohydrate ratio for adolescents with type 1 diabetes - a pilot study.
abstract: OBJECTIVE
  There is significant interest in the utility of flexible meal plans for individuals with type 1 diabetes. However, there is a paucity of data examining this approach in adolescents. The aim of this study was to assess glycemic control, weight status and quality of life over 12 months in adolescents with type 1 diabetes, who were commenced on a flexible meal plan using an insulin to carbohydrate ratio.
  
  
  METHODS
  38 adolescents with type 1 diabetes were recruited and 28 completed the study. Glyceamic control, weight status and quality of life were measured using haemoglobin A1c, BMI and the Diabetes Quality of Life -Youth questionnaire.
  
  
  RESULTS
  Nine months after the adolescents were transitioned to a flexible meal and insulin plan, mean BMI SDS decreased (by 0.15 ± 0.20; P < 0.001) and haemoglobin A1c increased (by 0.7 ± 0.83%; P = 0.001). Adolescents reported no change in the impact or concerns about diabetes. However, mean life satisfaction scores increased (5.5 ± 9.5; P = 0.008).
  
  
  CONCLUSIONS
  On a flexible meal and insulin plan glycemic control deteriorated although weight status and life satisfaction, two outcomes which may be important to the adolescents, improved. A flexible meal and insulin plan warrants further investigation as a management option.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia. rachel.hayes@health.nsw.gov.au
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Hayes
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Clarke
authors.forename: Nuala M
authors.initials: NM
authors.lastname: Harkin
authors.forename: Albert K F
authors.initials: AK
authors.lastname: Chan
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ambler
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy*; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D062407:Meals; D009752:Nutritional Status; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin