BMI Trajectory In Youth With New Onset T1DM: Can Increased Knowledge And Dietary Counseling Help?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 839-872-Diabetes & Obesity Management
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-845
Indrajit Majumdar*1, Kathleen Bethin2 and Teresa Quattrin3
1University at Buffalo, State University of New York and Women and Children's Hospital of Buffalo, NY, 2State University of NY at Buffalo, Buffalo, NY, 3University at Buffalo, State University of New York and Women and Children's Hospital of Buffalo, Buffalo, NY
Youth with type 1 diabetes (T1DM) may be overweight pre-diagnosis (dx) reflecting the trend in the general population. Thus, besides teaching carbohydrate (CHO) counting, a focus should be placed also on CHO quality to ensure optimal daily energy intake (DEI) and inclusion of recommended vegetable and fruit portions.

The aims of our study were: 1. To follow BMI trajectory from pre-dx to 6 months (mos) post-dx in youth with new onset (NO) T1DM randomized to Standard Dietary Counseling (SDC) compared to Enhanced Dietary Counseling (EDC); 2. To compare the changes in knowledge of age-specific DEI and daily CHO intake (DCI) in the each group from 6 weeks (wks) to 6 mos; 3. To examine changes in DEI, DCI and intake of fruit and vegetable portions in subjects receiving EDC.

Designs/Methods: Youth with NO-T1DM (ADA criteria) and positive autoantibody were approached between July 2011 and April 2012. Celiac disease, chronic steroids or ADHD Rx were exclusion criteria. After receiving SDC at dx, subjects were randomized at 6 wks post-dx to remain on SDC (n=25) or EDC (n=22). EDC group was counseled monthly via telephone on age-specific DEI, quality of CHO, and fruit and vegetable portions and filled 3-day food records (FRs) at 6 wks and 6 mos. Weights and heights were obtained from pediatricians’ records 3-12 mos prior to dx and measured at dx, 6 wks, 3 and 6 mos post-dx; %over BMI (%OBMI) was calculated as [(actual BMI – BMI at 50th percentile)/BMI at 50th percentile x 100]. To assess knowledge of DEI and DCI we developed questionnaires. Data were expressed as mean + SD. ANOVA and Fisher’s exact test were used for analysis.

Results: Of 63 potential participants, 47 (8.9 + 4.2 years, 51% females) were included. 2 declined and 14 had >1 exclusion criterion. %OBMI change from 6 wks to 6 mos post-dx was similar in SDC (5.8 + 8.7) vs. EDC (5.3+ 6.4). %OBMI at 6 mos exceeded pre-dx %OBMI in 76.1% and 56.2% of SDC and EDC subjects, respectively (ns). From 6 wks to 6 mos the % of subjects with DEI knowledge increased from 16% to 39% in SDC (P=0.09), and 32% to 62% in EDC (P=0.047). In EDC group, FRs indicated that DEI was in excess of recommended both at 6 wks (45% of subjects) and 6 mos (36%; ns); DCI excess was present in 20 % at 6wks and 18% at 6 mos. In youth exceeding DEI, energy intake improved from 195 in excess (6wks) to 175 kilocalories below recommended (6 mos, P= 0.016). % EDC subjects meeting recommended intake of vegetable and fruit portions in FRs changed (6 wks vs. 6 mos) from 35% to 45% (ns) and 25% to 64% (P= 0.04), respectively.

Conclusions:  By 6 mos post-dx, BMI increased in youth with NO-T1DM and %OBMI exceeded pre-dx levels in >50 % of youth despite receiving EDC, demonstrating increased knowledge of DEI, and documenting improved energy intake and CHO quality in FRs. Thus evaluating dietary habit and intake is a challenge and assessment of youth readiness to change and a family based approach may be needed to prevent excessive weight gain.  

ns: P>0.05

Nothing to Disclose: IM, KB, TQ

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm