The Diabetologist #24+25

in children.98 This indicates that with education and
support, patients can successfully implement the
CD and T1D food plans to maintain or improve A1C
levels.81
Bone Health
Osteoporosis and osteopenia are the most common
complications of undiagnosed or untreated
CD. Studies examining bone mineral density (BMD)
levels in adolescents and children with CD and T1D
have shown conflicting results, with some reporting
lower BMD in patients with CD and T1D 99,100
and another finding no difference.101 One pediatric
study stratified BMD results according to GFD adherence,
showing individuals who adhere strictly have
the same BMD as T1D control subjects, but those
with poor compliance to the GFD resulted in lower
BMD.102 Pediatric patients who followed a GFD
had improvement in BMD and bone mineral apparent
density Z scores.100 An adult study identified
lower BMD in T1D and undiagnosed CD.81,103
CONCLUSION
Medical nutrition therapy and insulin dosing is the
crux of T1D management. There are limited randomized,
well-controlled clinical trials evaluating nutrition
and T1D; however, many general principles
apply and have been presented. Whether an individual
meticulously counts carbohydrates and adjusts
each mealtime insulin dose, or “guesstimates”
portions, T1D management always involves extensive
nutrition knowledge. Critical to any success is
the involvement of an RD well versed in T1D management.
This is true whether treating a child or an
adult. Clearly a team approach is needed and other
health care providers should be familiar with medical
nutrition therapy, but the RD is the key resource.
With appropriate guidance, ongoing support and
encouragement, individuals with T1D and their families
can succeed at learning and applying medical
nutrition therapy, improve diabetes control, minimize
long-term complications, and enjoy a higher quality
of life.
Gaps in Nutritional Education and Support for People
with T1D
1. Include documentation of food intake and fixed
meals in drug and device studies to better understand
impact of food, combinations of food, and
timing of meals.
2. Undertake more research on best method for
teaching carbohydrate counting that creates sustainable
impact on diabetes management.
3. Initiate research on eating patterns to identify
those that optimize glucose management; include
evaluation of random eating patterns vs. consistent
eating patterns.
4. Develop real-time tools for assisting patients in
estimating carbohydrate count of a meal or snack.
5. Continue to work on ways to better identify and
treat nutritional issues in those with T1D and eating
disorders, CD, and various subgroups such as the
elderly and the obese
06
issue 24 - 25 < SEP./OCT. 2013