Quantitative assessment of dietary intake in adults with Type 1 diabetes following flexible insulin therapy education with an active promotion of dietary freedom.
Clinical practice guidelines for diabetes include dietary guidelines to address the increased risk of cardiovascular disease.


OBJECTIVE
To identify impact of flexible insulin education with an active promotion of dietary freedom on energy and macronutrient intake and achievement of nutrient recommendations in adults with Type 1 diabetes.


METHODS
Dietary assessment was performed prior to and 12months following flexible insulin education. Nutrient intake and the proportion achieving the European Association for the Study of Diabetes (EASD) nutrient guidelines were compared at baseline and post course.


RESULTS
Dietary data were available for 46 participants. Post course reductions were seen in median [IQR] energy kcal/d (1799 [1521-1931] to 1592 [1378-1940], p=0.002), fibre g/1000kcal (14 [12-16] to 13 [11-15], p=0.047), protein g/day (89 ([78-108] to 82 [74-93], p=0.001) and carbohydrate g/day (198 [172-330] to 162 [143-204], p=<0.001). The proportion experiencing at least 1 severe hypoglycaemia event over 12months was significantly reduced (χ(2)=7.7, p=0.006) from baseline (n=13, 26%) to post course (n=3, 6%). Achievement of EASD guidelines was poor and did not change post course.


CONCLUSIONS
Flexible insulin education with an active promotion of dietary freedom does not appear to 'worsen' the achievement of EASD nutrition guidelines in adults with Type 1 diabetes. On the contrary, the dietary changes observed were reductions in energy, carbohydrate and protein intake. Flexible insulin education may offer benefits in enabling reduced energy intake without increasing hypoglycaemia.
Queensland Diabetes Centre, Mater Health Services, Raymond Tce, South Brisbane, Australia; Lady Cilento Children's Hospital, Stanley Street, South Brisbane, Australia. Electronic address: bk24tips@tpg.com.au.
Brigid A
BA
Knight
Dept of Nutrition & Dietetics, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Australia; Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Australia; Mater Clinical School, University of Queensland, Raymond Tce, South Brisbane, Australia.
Ingrid J
IJ
Hickman
Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Australia.
Kristen
K
Gibbons
Queensland Diabetes Centre, Mater Health Services, Raymond Tce, South Brisbane, Australia; Mater Research Institute, University of Queensland, Raymond Tce, South Brisbane, Australia; Mater Clinical School, University of Queensland, Raymond Tce, South Brisbane, Australia.
Harold D
HD
McIntyre
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D004032:Diet; D003927:Diet, Diabetic / Q000379:methods*; D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D004044:Dietary Proteins; D002149:Energy Intake; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D010353:Patient Education as Topic
D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D004044:Dietary Proteins; D007004:Hypoglycemic Agents; D007328:Insulin
Cardiovascular disease; Diabetes; Diet; Flexible insulin; Nutrition