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Pre-prandial Insulin & Meal Routine Can Help Children with Type 1

Sep 10, 2019
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Does giving children with type 1 diabetes pre-prandial insulin help them lower their HbA1c?

In previous studies, researchers observed that children are more prone to have an increased intake of saturated fats, and that children with type 1 diabetes are less likely to consume fruits and vegetables.  Parents are having a difficult time managing their children’s diabetes care at mealtimes because their appetites are random and sporadic. 

In this study, the primary outcome was to evaluate children with type 1 diabetes in Newcastle, Australia, to understand how dietary intake and meal-time routines have affected their glycemic control. The study included a secondary outcome that evaluated how nutritional intake and eating habits affected Hemoglobin A1c levels. Researchers examined the medical records of 22 children that are 7 years of age or younger with type 1 diabetes. The mean age of these children was 5 years of age, 55% of the pediatric patients were boys, and the mean HbA1c was 6.4%.  The children’s parents were asked to weigh all the foods and drinks that they consumed for 3 days. They were given scales or measuring cups to weigh out food, and asked to state how they prepared the food, and the type of food and brand name. Parents were asked to complete a questionnaire about diabetes management and eating habits. 

Most children consumed an average of 3 meals, with 81% having both morning and afternoon snacks.  The mean macronutrients distribution for consumed foods includes 48% of carbohydrate, 33% of fats (including 15% of saturated fats), and 16% of proteins.  Many of the children did not consume the daily requirement for vegetables, meat, and proteins. 19% of parents reported that they gave their children food at a frequent rate with undefined portions.  

In this trial, the researchers did not find any connection with carbohydrates, fat or protein intake when measuring the level of HbA1c (P >0.05).  Nevertheless, there was an increase in HbA1c in children that were frequently fed and ate undefined portions (7.7%) versus children obtaining regular meals with pre-prandial insulin (6.1%) (P= 0.01).  Researchers discovered that these children were consuming similar numbers of macronutrients as children in the same age category that have not been diagnosed with diabetes.   

This study concluded that children with type 1 diabetes are likely to achieve glycemic control when they are receiving insulin before meals and have a set meal routine, as opposed to eating when they are hungry.  It is important to know that the population size of this study was small and may not apply to the real world. Further studies should evaluate more children with type 1 diabetes to have a holistic view of how pre-prandial insulin works with routine mealtimes.  

Practice Pearls:

  • Children who take pre-prandial insulin and have a routine meal schedule are more likely to achieve glycemic control compared to children who eat sporadically.
  • Many parents do not serve enough vegetables, meats, and protein for children to achieve the daily requirement of these foods.
  • There was no connection between carbohydrates, fat or protein consumption when it came to an increase or decrease in HbA1c levels.

BMJ Open Diabetes Res Care. “Routine Mealtimes, Preprandial Insulin Help Children with Type 1 Diabetes Achieve Glycemic Targets.” Healio, www.healio.com/endocrinology/diabetes/news/online/{99bc78ea-1307-43b0-9bdc-e8c48318a1e0}/routine-mealtimes-preprandial-insulin-help-children-with-type-1-diabetes-achieve-glycemic-targets?M_BT=2469436429117.

Seckold, Rowen, et al. “Dietary Intake and Eating Patterns of Young Children with Type 1 Diabetes Achieving Glycemic Targets.” BMJ Open Diabetes Research & Care, BMJ Specialist Journals, 1 June 2019, drc.bmj.com/content/7/1/e000663?utm_source=alert&utm_medium=email&utm_campaign=bmjdrc&utm_content=latest&utm_term=12072019.

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences