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Systematic Review

The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

1
Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria
2
Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria
3
Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria
4
Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, 5020 Salzburg, Austria
*
Author to whom correspondence should be addressed.
Academic Editors: Dénes Molnár and Éva Erhardt
Received: 29 August 2021 / Revised: 2 October 2021 / Accepted: 5 October 2021 / Published: 11 October 2021
Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary. View Full-Text
Keywords: diabetes; type 1 diabetes mellitus; children; fat; protein; nutrition; high fat; high protein; mixed meal; paediatric; insulin diabetes; type 1 diabetes mellitus; children; fat; protein; nutrition; high fat; high protein; mixed meal; paediatric; insulin
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MDPI and ACS Style

Furthner, D.; Lukas, A.; Schneider, A.M.; Mörwald, K.; Maruszczak, K.; Gombos, P.; Gomahr, J.; Steigleder-Schweiger, C.; Weghuber, D.; Pixner, T. The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps. Nutrients 2021, 13, 3558. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103558

AMA Style

Furthner D, Lukas A, Schneider AM, Mörwald K, Maruszczak K, Gombos P, Gomahr J, Steigleder-Schweiger C, Weghuber D, Pixner T. The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps. Nutrients. 2021; 13(10):3558. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103558

Chicago/Turabian Style

Furthner, Dieter, Andreas Lukas, Anna M. Schneider, Katharina Mörwald, Katharina Maruszczak, Petra Gombos, Julian Gomahr, Claudia Steigleder-Schweiger, Daniel Weghuber, and Thomas Pixner. 2021. "The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps" Nutrients 13, no. 10: 3558. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103558

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