Pressing Need to Increase Adherence to Dietary Recommendations in Indian Children with T1DM

Medical nutrition therapy is a crucial component in the management of children with type 1 diabetes (T1D). Yet, adherence to dietary guidelines remains suboptimal. Children with T1D do not require restrictive or special diets but demand healthy eating that applies to all children. The 2018 guidelines from the International Society for Pediatric and Adolescent Diabetes (ISPAD) emphasize a balanced intake of macronutrients, recommending that carbohydrates account for 45-55% of daily energy intake, fats 30-35%, and proteins 15-20% while limiting sucrose and saturated fatty acids to 10% of total energy.

However, there are significant challenges in ensuring adherence to these recommendations, like maintaining dietary adequacy and diversity, optimizing glycemic control, ensuring sufficient micronutrient intake, and fostering healthy eating habits. Ideally, dietary plans for children with T1D should be individualized, considering factors such as age, gender, physical activity, and the developmental phase of puberty. However, busy outpatient clinics often lack the time needed to provide in-depth nutritional counseling, which can prevent families from getting individualized dietary regimens needed to effectively manage their child's diet and diabetes.

A study evaluating adherence to ISPAD dietary recommendations found that only 40% of children with T1D met the guidelines. Mean calorie intake from carbohydrates, fats, and proteins was 51.93%, 32.42%, and 15.95%, respectively, with 68% of participants falling short of their estimated energy requirements. Importantly, children who adhered to the guidelines had better glycemic control, with lower HbA1c levels compared to those who did not.

The findings highlight an urgent need for healthcare professionals to address these gaps. To improve adherence, healthcare providers must prioritize individualized meal planning and education, ensuring that both children and their caregivers have the knowledge and resources they need to meet dietary recommendations.

Kundu K, Singh P, Seth A. Adherence to Dietary Recommendations in Children With Type 1 Diabetes: A Cross- Sectional Study. Indian Pediatrics. 2024;61.