Carbohydrates intake in children and adolescents with type 1 diabetes mellitus and its relation with physical activity

Introduction: A carbohydrate (CHO) intake of 6-10 g/kg/day is recommended in active children and adolescents. It is not known whether individuals with type 1 diabetes mellitus (T1DM) fulfill this recommendation. Objectives: To investigate CHO intake in children and adolescents with T1DM in relation to physical activity (PA). Methods: Retrospective analysis on all children and adolescents with T1DM using the Bolus Wizard feature in the Medtronic Minimed 780G aHCL system. Clinical data were collected from medical records of the last visit and for the 30 days before from Carelink reports. Results: Data from 83 individuals with T1DM were collected, 50% (n=41) females, with a median age of 14.2 years (IQR 10.7;17.6). Among them, 47% (n=39) were sedentary (little or no PA), while 53% (n=44) performed regular PA for a median of 3 days per week (IQR 2;4) (n=25 <3 times/week, n=17 4-5 times/week, n=2 ≥6 times/week). Overall, the median CHO intake was 3.8 g/kg/day (IQR 2.3;5.0), with a coefficient of variation of 30.7% (IQR 21.1;43.3). No significant differences were found in CHO intake between those who were sedentary (median 3.5 g/kg/day [IQR 1.9;5.6]) and those who engaged in regular PA (median 4.1 g/kg/day [IQR 2.9;5.0], p=0.155), and no significant correlation with days per week of PA (ρ=0.108, p=0.334). Swimming had the highest CHO intake (median 5.9 g/kg/day [IQR 3.3;8.9]), with no significant differences compared to other sports or inactivity (p=0.983). In multivariate analysis, CHO intake was associated with the rate of correction boluses (β=-4.15, p<0.001), number of meals (β=0.38, p<0.001), weight (β per kg=-0.05, p<0.001), total daily insulin (β per U/day=0.03, p=0.002), and sex (β of being female=-0.29, p=0.033), but not with age, TIR, or PA. Conclusions: Greater attention should be paid to CHO intake in young individuals with T1DM engaging in regular PA, as the amount of CHO in the diet might be insufficient. Moreover, every 1% increase in correction boluses is associated with 4 g of CHO unannounced in the aHCL system.