title: Carbohydrate intake and insulin requirement in children, adolescents and young adults with cystic fibrosis-related diabetes: A multicenter comparison to type 1 diabetes.
abstract: OBJECTIVE
  In cystic fibrosis-related diabetes (CFRD), energy needs differ from type 1 (T1D) or type 2 diabetes, and endogenous insulin secretion is not totally absent. We analyzed whether daily carbohydrate intake, its diurnal distribution and insulin requirement per 11 g of carbohydrate differ between CFRD and T1D.
  
  
  METHODS
  Anonymized data of 223 CFRD and 36,780 T1D patients aged from 10 to <30 years from the multicenter diabetes registry DPV were studied. Carbohydrate intake and insulin requirement were analyzed using multivariable regression modeling with adjustment for age and sex. Moreover, carbohydrate intake was compared to the respective recommendations (CFRD: energy intake 130% of general population with 45% carbohydrates; T1D: carbohydrate intake 50% of total energy).
  
  
  RESULTS
  After demographic adjustment, carbohydrate intake (238 ± 4 vs. 191 ± 1 g/d, p < 0.001) and meal-related insulin (0.52 ± 0.02 vs. 0.47 ± 0.004 IU/kg*d, p = 0.001) were higher in CFRD, whereas basal insulin (0.27 ± 0.01 vs. 0.38 ± 0.004 IU/kg*d, p < 0.001) and total insulin requirement per 11 g of carbohydrate (1.15 ± 0.06 vs. 1.70 ± 0.01 IU/d, p < 0.001) were lower compared to T1D. CFRD patients achieved 62% [Q1;Q3: 47; 77] of recommended carbohydrate intake and T1D patients 60% [51; 71] of age- and gender-specific recommended intake (p < 0.001). CFRD and T1D patients had a carbohydrate intake below healthy peers (79% [58; 100] and 62% [52; 74], p < 0.001). The circadian rhythm of insulin sensitivity persisted in CFRD and the diurnal distribution of carbohydrates was comparable between groups.
  
  
  CONCLUSIONS
  In pediatric and young adult patients, carbohydrate intake and insulin requirement differ clearly between CFRD and T1D. However, both CFRD and T1D patients seem to restrict carbohydrates.
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, 89081 Ulm, Germany. Electronic address: nicole.scheuing@uni-ulm.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Scheuing
authors.affiliation: Hannover Medical School, Department of Pediatrics, 30625 Hannover, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Thon
authors.affiliation: University Children's Hospital Essen, Department of Pediatrics II, 45147 Essen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Konrad
authors.affiliation: Gynecological and Children Hospital, Department of Children and Adolescent Medicine, 4020 Linz, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Clinic Bremen-Mitte, Center for Pediatrics and Adolescent Medicine, 28177 Bremen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Karsten
authors.affiliation: University Children's Hospital Düsseldorf, Department of General Pediatrics, Neonatology and Pediatric Cardiology, 40225 Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meissner
authors.affiliation: University Hospital of Freiburg, Department of Internal Medicine II, Division of Endocrinology and Diabetology, 79106 Freiburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Seufert
authors.affiliation: University of Cologne, Department of Pediatrics, 50937 Cologne, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Schönau
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Medical Department I, Division of Endocrinology & Diabetes, 91054 Erlangen, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Schöfl
authors.affiliation: University of Bonn, Department of Pediatric Endocrinology and Diabetes, 53127 Bonn, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Woelfle
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, 89081 Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D002648:Child; D003550:Cystic Fibrosis / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000097:blood; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009751:Nutritional Requirements; D011446:Prospective Studies; D064167:Recommended Dietary Allowances; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin
keywords: Adolescent; Child; Cystic fibrosis; Diabetes mellitus; Dietary carbohydrates; Insulin dose