Success in dietary management is critical to achieving near normal glycemic control in young children with type 1 diabetes mellitus (T1DM). Children who eat a diet high in fruits and vegetables and low in fat can achieve good glycemic control and reduce their risk for obesity and long-term diabetes-related complications, including dyslipidemia and cardiovascular disease (CVD). It is important to focus on diet in young children with T1DM because data suggest 7% of 3-9 year olds have 2 or more risk factors for CVD and given the general trend toward overweight in the US, this percent could now be higher. The rapid uptake of intensive insulin therapy in youth with T1DM has revolutionized diabetes management, but data show that adolescents who follow this regimen emphasize carbohydrate content in meal planning to the exclusion of other macronutrients. This has led many adolescents with T1DM to consume a diet that is low in fruit and vegetable intake and relatively high in fat intake. The result of this diet is weight gain and increased risk for dyslipidemia and CVD in addition to having T1DM. Preliminary data from the candidate's K23 suggest that young children with T1DM consume a diet similar to adolescents, but we do not know if parents'of young children share a similar bias for foods low in carbohydrate content or if they perceive other barriers to healthy eating. It is important to research these questions because their answers would directly inform dietary interventions for young children with T1DM and the K candidate speculates that without also addressing diet, a behavior-only intervention would not be successful in changing glycemic control in young children.
The aims are 1) to collect qualitative data examining parents'understanding of nutrition in T1DM and the reasons underlying their dietary management and 2) to examine factors of the food environment impacting parents'dietary management. The proposed study is significant because it will produce data revealing parents'understanding of nutrition in T1DM and the factors underlying their food choices, which are necessary to identify how to change parents'dietary management. The central hypothesis is that parents'misunderstanding of healthful eating practices for T1DM and elements of children's food environment are barriers to success in dietary management. The study approach will be a mixed-methods research design using structured and semi-structured interviews, validated assessments of the food environment, and quantitative parent questionnaires. The proposed study will expand the K candidate's current K23 program and provide new data to inform future intervention development. The study is innovative because of its exclusive and in-depth focus on young children on intensive regimens and its examination of two novel factors that are important to dietary management: parents'understanding of a healthful diabetes diet and their perception of external barriers to a healthful diet.
The aims compliment the candidate's K23 work in young children with T1DM and her long-term goal to develop interventions that can change health outcomes early for these patients and forestall the development of diabetes-related complications.
The proposed research is relevant to public health because type 1 diabetes is common in children and sub- optimal diabetes management can lead to increased morbidity and mortality in patients. Healthy eating is key to better glycemic control and reduced risk for long-term diabetes-related complications. Thus, the proposed research is relevant to the part of NIH's mission that pertains to developing fundamental knowledge to extend healthy life and reduce the burden of illness.
