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ADA/JDRF Type 1 Diabetes Sourcebook, Excerpt #8: Nutrition, Part 4

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.

Next Text: Chapter 11 Physical Activity: Regulation of Glucose Metabolism, Clinical Management Strategies, and Weight Control
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