Glycemic Control as a Function of Breakfast Macronutrients and Physical Activity Timing in Young Children with Type 1 Diabetes

Background: Incidence of T1D is increasing in young children (\u3c 7 years). During this sensitive developmental period, daily medical regimens are needed to prevent T1D complications commonly seen later in life. Diabetes management for young children relies solely on parents, and factors related to glycemic control and variability have not been well studied in this age group. Objective: To characterize blood glucose (BG), energy expenditure, diet and physical activity (PA) patterns in a small cohort of young children with type 1 diabetes (T1D). Method: 10 children aged 3-7 years (Mage= 5.88, 80% female) with T1D for at least 1 yr (2.78 ± 1.55 years) participated. For five days, participants wore blinded continuous glucose monitors (CGM) and actigraphs as objective measures of BG and PA, respectively, and parents completed daily 24 hour interviews (e.g., diet, BG monitoring). Parents also completed the Physical Activity Questionnaire (PAQ). Medical chart review was completed for the year prior to participation. Results: Glycemic control was overall good: M A1c = 7.27%± 0.69; six participants’ A1c’s \u3c 7.5 (within the 2015 American Diabetes Association (ADA) pediatric targets). Participants completed 6.32±2.15 BG checks/day and spent an average of 61% of the 5 day period above the ADA suggested BG range of 90-150 mg/dL and 18% below range. All parents reported satisfaction with their child’s PA; however, results showed kids received significantly less PA than the 60 minutes per day recommended by American Academy of Pediatrics (Average PAQ score = 2.46 ±0.61; actigraph = 19.51 moderate to vigorous min/day ±24.67). Participants consumed a mean of 1530.91± 331.08 kilo calories/day (46% carbohydrates, 18% protein, and 15% fat) generally in line with recommendations for healthy children. There was no association between moderate-vigorous PA and time spent in low BG excursions (r = 0.27, p = 0.45). Participants who engaged in PA during the morning as well as afternoon trended toward less time in overall BG excursions (ρ = 0.55, p = 0.06). Conclusions: Even young children meeting targets for A1c spend a significant portion of their day outside of the recommended BG range. Young children are more sedentary than parents perceive, and even short amounts of PA after each meal may have an impact on glycemic control for the remainder of the day