Barriers to dietary adherence and metabolic effects of adherence in carbohydrate counter children and adolescents with TYPE 1 diabetes

The aim of the present study was to investigate the nutritional status, to teach or improve knowledge and skills for carbohydrate counting, to determine the compliance of this method and the effect of compliance to metabolic control of the children and adolescents with type 1 diabetes. The study was conducted at Pediatric Endocrinology Clinic of the Gülhane Military Medical Academy Department of Child Health and Diseases between 2013 and 2015 on 53 child and adolescent (25 males, 28 females) diagnosed with type 1 diabetes, aged between 2-18 years old and under intensive insulin treatment. Beginner carbohydrate counters and the ones with compliance problem were included in the study. A questionnaire was applied to patients and parents including demographic and disease characteristics, dietary habits and thoughts and behaviours about carbohydrate counting sections. 28 girls (52.8%) and 25 boys (47.2%) were included in the study. The mean weight for age, lenght for age and BMI for age z scores of the patients were similar before and after carbohydrate counting (p>0.05). The median serum HbA1c level of the patients was 7.9% and 8.0% before and after carbohydrate counting, respectively (p>0.05). The mean serum LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerid levels were found to be low at the end of the study compared to baseline results (p>0.05). In the 0-6 age group, the mean daily energy intake were similar before and after carbohydrate counting (p>0.05), energy intake decreased at the end of the study in other age groups (p<0.05). Non-adherence to carbohydrate counting was 100.0% and 33.3% in 6 years old or younger boys and girls, respectively. In the 6-12 age group, non-adherence was 71.4% in girls and 28.6% in boys. In the adolescent group, non-adherence was 37.5% in girls and 50.0% in boys. Patients' or parents' adherence and skills with regard to carbohydrate counting determined at the end of the sixth month and they were classified as adherer or non-adherer according to their results to a daily menu carbohydrate content estimation and accurate detection of insulin doses. 3 day food records, physical activity records, anthropometric measurements and biochemical parameters of patients were taken twice at the beginning and end of the study. 60% of the adherer patients and 21.7% of the non-adherer patients had serum HbA1c levels <7.5% (p<0.05). The educational level of the mothers of adherer patients was found to be higher (p <0.05). It was determined that 56.2% of the non-adherer patients consulted with dietitian less than once in a year. BMI for age z scores didn't differ by adherence to carbohydrate counting (p>0.05). Serum lipid parameters of adherer and non-adherer patients were found similar (p>0.05). As a result, adherence to diet in adolescents was low compared to other age groups and education levels of mothers and frequency of dietitian control was found to affect adherence. Diabetes spesific complications and deterioation in glycemic control may decrease with regular monitoring and supporting type 1 diabetic patients and their families for carbohydrate counting. Key words: Type 1 diabetes, carbohydrate counting, children, adolescents, adherence