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Weight trajectory of youth with new-onset type 1 diabetes comparing standard and enhanced dietary education

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Abstract

Youth with type 1 diabetes (T1DM) gain weight after insulin therapy initiation. We aimed to study the effects of Enhanced Dietary Counseling (EDC) compared to Standard of Care Dietary Counseling (SDC) on BMI trajectory in youth with new-onset T1DM. Youth with new-onset T1DM (n = 47; 8.9 + 4.2 years) were randomized 6 weeks post-diagnosis to either SDC per American Diabetes Association guidelines (n = 25) or EDC (n = 22: SDC plus monthly nutritional education and 3-day food records (FRs) at 6 and 24 weeks). Weights and heights were measured at diagnosis, 6 weeks, 3, 6, and 12 months post-diagnosis; pre-diagnosis BMI was obtained from pediatricians’ records. BMI Z score was used to track BMI change. Knowledge of recommended daily energy intake (DEI) and daily carbohydrate intake was assessed at follow-up visits. Changes in BMI Z scores were similar in SDC versus EDC subjects from pre-diagnosis to 12 months post-diagnosis. BMI Z score at 12 months exceeded pre-diagnosis level in 58.5 % subjects (54.5 % EDC vs. 63.1 % SDC, p = 0.75). From 6 weeks to 6 months, percentage of subjects correctly recalling recommended DEI increased in EDC along with percentage of subjects meeting recommended daily fruit servings intake from 25 % (6 weeks) to 64 % (6 months), p = 0.047). EDC did not prevent BMI Z score increases in youth with new-onset T1DM, and BMI Z score exceeded pre-diagnosis levels in >50 % 12 months post-diagnosis. A family-based approach and/or additional intervention may be needed to prevent excessive weight gain.

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Acknowledgements

The authors would like to acknowledge the support provided by the staff, fellows, and faculty at the diabetes center of Women and Children’s Hospital of Buffalo who ensured follow-up of patients per protocol. We would like to thank Michelle Ecker, RD, CDE for her assistance in developing user friendly paper and electronic food records. The authors would also like to acknowledge the contributions of Chang-Xing Ma, PhD, Associate Professor, Department of Biostatistics, for his help in randomization of subjects and statistical analysis. We would also like to thank Ms. Sherry Ortiz for her assistance in preparation of the tables and figures.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo & Women and Children’s Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA

    Indrajit Majumdar, Kathleen Bethin & Teresa Quattrin

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  1. Indrajit Majumdar
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  2. Kathleen Bethin
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  3. Teresa Quattrin
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Correspondence to Indrajit Majumdar.

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Majumdar, I., Bethin, K. & Quattrin, T. Weight trajectory of youth with new-onset type 1 diabetes comparing standard and enhanced dietary education. Endocrine 49, 155–162 (2015). https://doi.org/10.1007/s12020-014-0469-6

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