Search

OBJECTIVE: Maintenance of glycemic control during and after exercise remains a major challenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear. RESEARCH DESIGN AND METHODS: The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multiple daily injection [MDI] users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data. RESULTS: A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8% [49 ± 8.7 mmol/mol]) assigned to structured aerobic (n = 162), interval (n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was −18 ± 39, −14 ± 32, and −9 ± 36 mg/dL for aerobic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70–180 mg/dL (3.9–10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001). CONCLUSIONS: Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improvement in glucose time in range but may have slightly increased time below range. [ABSTRACT FROM AUTHOR]

Objective This study examined the dietary intake, dietary adherence, and associated daily glycemic control of young children (mean age 5.6 [+ or -] 1.6 years) with type 1 diabetes in 33 families. Design This was a one-sample cross-sectional study. Children's nutrient and energy intakes were measured using 3-day diet diaries. Children's mean daily blood glucose levels were assessed prospectively for 2 weeks using the FreeStyle (TheraSense, Inc, Alameda, CA) home blood glucose meter. Statistical analysis Means, standard deviations, and frequencies described the sample. Associations between dietary adherence and glycemic control were examined by one-tailed Pearson correlations. Results Mean nutrient intakes were less than the Dietary Reference Intake for children's intake of vitamin B-12 and calcium. Children's dietary deviations revealed better-than-predicted adherence to the number and timing of feedings per day and number of carbohydrate units consumed per meal. In contrast, children's daily carbohydrate intake was approximately 80% [+ or -] 21% of the recommended levels based on their weight and age. In addition, children's energy intake was only 78% [+ or -] 18% of the recommended levels based on age. Correlations revealed a positive association between poor dietary adherence and higher blood glucose levels. Conclusions Young children with type 1 diabetes are likely to have adequate dietary intake of most micronutrients. However, their adherence to specific carbohydrate and energy intake recommendations may be lower. Because the preschool years represent a period of rapid growth, diet plans for preschoolers with diabetes need to be revised often for optimal management of type 1 diabetes. Close adherence to dietary recommendations is one behavior that may improve blood glucose control in young children with diabetes.

Objective To compare the micronutrient and energy intake of infants and toddlers with cystic fibrosis (CF) to the intake of matched control children and dietary reference index (DRI) levels. Design A two-group comparison study. Nutrient and energy intakes were measured via 3-day diet diaries. Anthropometric data were collected within 1 week of study enrollment. Subjects/setting A clinical sample of 35 infants and toddlers with CF (mean=18.6, SD=8.1 months) matched to a community sample of 34 healthy controls. Statistical analyses performed Children with CF and controls were compared on anthropometric and nutrient data using independent sample t tests. Mean nutrient and energy intake for children in each group were compared with the age-appropriate DRI for targeted nutrients using percentages. Results Children with CF and controls were similar on measures of growth (height, weight, or weight-for-height percentile). Four children with CF were at or below the 10th percentile for weight-for-height, compared with one control child. Children with CF and controls did not differ on average daily protein, calcium, zinc, and energy intake. Overall, children met or exceeded DRI levels for nutrient intakes. A notable exception was iron, for which mean intakes were lower for control children. Toddlers with CF consumed only 89% of the RDA per day for energy. Applications/conclusions Infants and toddlers with CF are likely obtaining adequate micronutrient intakes from food. Interventions to increase total energy intake in infants and toddlers with CF are needed. Dietitians may want to focus more on calorie intake and percent calories from fat than on micronutrient intake in their nutrition counseling in young children with CF. J Am Diet Assoc. 2003;103:1620-1625.

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/ rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups. [ABSTRACT FROM AUTHOR]