Dr Carmel Smart

Dr Carmel Smart

Conjoint Senior Lecturer

School of Health Sciences

Career Summary

Biography

Dr. Carmel Smart is a clinical researcher and practitioner who is internationally recognised as a leading authority in nutrition and type 1 diabetes.  Carmel has developed international partnerships and research collaborations aimed at improving the nutritional care of children living with diabetes.

Dr Smart holds appointments as a Senior Diabetes Dietitian and Clinical Research Fellow at the John Hunter Children’s Hospital and is a Conjoint Senior Lecturer at the University of Newcastle. Carmel led the 2014 and 2018 International Paediatric Diabetes Clinical Nutrition Guidelines and is a lead investigator in the Australian Type 1 Diabetes Clinical Research Network.   She served on the International Society of Paediatric and Adolescent Diabetes executive and was the convenor of the Science School for Health Professionals. Dr Smart is currently appointed to JDRF International Type 1 Exercise Expert Advisory Group and is a senior practitioner member of the Australian Dietetic Council. She has written chapters for numerous books on diabetes including the American Diabetes Association Nutrition Therapy Guidelines released in 2017 and publishes in leading diabetes journals.   

  

Qualifications

  • Doctor of Philosophy, University of Newcastle
  • Graduate Diploma in Nutrition and Dietetics, Queensland Institute of Technology

Keywords

  • Diabetes
  • Nutrition
  • Paediatrics
  • Insulin Pump Therapy
  • Mulitiple Daily injections
  • Exercise

Fields of Research

Code Description Percentage
110306 Endocrinology 40
111101 Clinical and Sports Nutrition 40
111499 Paediatrics and Reproductive Medicine not elsewhere classified 20
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (28 outputs)

Year Citation Altmetrics Link
2018 de Bock M, Lobley K, Anderson D, Davis E, Donaghue K, Pappas M, et al., 'Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: An illustrative case series', Pediatric Diabetes, 19 129-137 (2018) [C1]

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Low carbohydrate diets for the management of type 1 diabetes have been popularised by social media. Th... [more]

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Low carbohydrate diets for the management of type 1 diabetes have been popularised by social media. The promotion of a low carbohydrate diet in lay media is in contrast to published pediatric diabetes guidelines that endorse a balanced diet from a variety of foods for optimal growth and development in children with type 1 diabetes. This can be a source of conflict in clinical practice. We describe a series of 6 cases where adoption of a low carbohydrate diet in children impacted growth and cardiovascular risk factors with potential long-term sequelae. These cases support current clinical guidelines for children with diabetes that promote a diet where total energy intake is derived from balanced macronutrient sources.

DOI 10.1111/pedi.12527
Citations Scopus - 2
2018 Phelan H, King B, Anderson D, Crock P, Lopez P, Smart C, 'Young children with type 1 diabetes can achieve glycemic targets without hypoglycemia: Results of a novel intensive diabetes management program', Pediatric Diabetes, 19 769-775 (2018) [C1]

© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Young children with type 1 diabetes (T1D) present unique challenges for intensive diabetes... [more]

© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Young children with type 1 diabetes (T1D) present unique challenges for intensive diabetes management. We describe an intensive diabetes program adapted for young children and compare glycemic control, anthropometry, dietary practices and insulin regimens before and after implementation. Methods: Cross sectional data from children with T1D aged =0.5 to <7.0 years attending the John Hunter Children's Hospital (JHCH), Australia in 2004, 2010 and 2016 were compared. Outcome measures were glycemic control assessed by hemoglobin A1c(HbA1c); severe hypoglycemia episodes; body mass index standard deviation scores (BMI-SDS); diabetes ketoacidosis (DKA) episodes; and insulin regimen¿twice daily injections, multiple daily injections, or continuous subcutaneous insulin infusion. Results: Mean HbA1cdeclined by 12 mmol/mol over the study period (P <.01). The proportion of children achieving a mean HbA1c< 58 mmol/mol increased significantly from 31% in 2004 to 64% in 2010 (P <.01), and from 64% in 2010 to 83% in 2016 (P =.04). The mean BMI-SDS was significantly lower in 2010 when compared with 2004 (P<.01); however, this trend plateaued between 2010 and 2016 (P =.97). Severe hypoglycemia and DKA occurred infrequently. The prevalence of overweight or obesity increased from 2010 to 2016 (P =.03). Conclusions: The JHCH intensive diabetes management program has resulted in 83% of young children in 2016 achieving target glycemia without an increase in severe hypoglycemia or DKA. Overweight remains a challenge in this population warranting action to reduce weight and protect these children from future obesity-related health risks.

DOI 10.1111/pedi.12644
Co-authors Bruce King
2018 Lopez PE, Evans M, King BR, Jones TW, Bell K, McElduff P, et al., 'A randomized comparison of three prandial insulin dosing algorithms for children and adolescents with Type 1 diabetes.', Diabet Med, (2018)
DOI 10.1111/dme.13703
Co-authors Bruce King, Patrick Mcelduff
2017 Paterson MA, Smart CEM, Lopez PE, Howley P, McElduff P, Attia J, et al., 'Increasing the protein quantity in a meal results in dose-dependent effects on postprandial glucose levels in individuals with Type 1 diabetes mellitus', Diabetic Medicine, 34 851-854 (2017) [C1]

© 2017 Diabetes UK Aim: To determine the glycaemic impact of increasing protein quantities when consumed with consistent amounts of carbohydrate in individuals with Type 1 diabete... [more]

© 2017 Diabetes UK Aim: To determine the glycaemic impact of increasing protein quantities when consumed with consistent amounts of carbohydrate in individuals with Type 1 diabetes on intensive insulin therapy. Methods: Participants with Type 1 diabetes [aged 10¿40 years, HbA1c= 64 mmol/mol (8%), BMI = 91st percentile] received a 30-g carbohydrate (negligible fat) test drink daily over 5 days in randomized order. Protein (whey isolate 0 g/kg carbohydrate, 0 g/kg lipid) was added in amounts of 0 (control), 12.5, 25, 50 and 75 g. A standardized dose of insulin was given for the carbohydrate. Postprandial glycaemia was assessed by 5 h of continuous glucose monitoring. Results: Data were collected from 27 participants (15 male). A dose¿response relationship was found with increasing amount of protein. A significant negative relationship between protein dose and mean excursion was seen at the 30- and 60-min time points (P = 0.007 and P = 0.002, respectively). No significant relationship was seen at the 90- and 120-min time points. Thereafter, the dose¿response relationship inverted, such that there was a significant positive relationship for each of the 150¿300-min time points (P < 0.004). Mean glycaemic excursions were significantly greater for all protein-added test drinks from 150 to 300 min (P < 0.005) with the 75-g protein load, resulting in a mean excursion that was 5 mmol/l higher when compared with the control test drink (P < 0.001). Conclusions: Increasing protein quantity in a low-fat meal containing consistent amounts of carbohydrate decreases glucose excursions in the early (0¿60-min) postprandial period and then increases in the later postprandial period in a dose-dependent manner.

DOI 10.1111/dme.13347
Citations Scopus - 3Web of Science - 3
Co-authors Bruce King, Peter Howley, Patrick Mcelduff, John Attia
2017 Sundberg F, Barnard K, Cato A, de Beaufort C, DiMeglio LA, Dooley G, et al., 'ISPAD Guidelines. Managing diabetes in preschool children.', Pediatric diabetes, 18 499-517 (2017) [C1]
DOI 10.1111/pedi.12554
Citations Scopus - 2Web of Science - 2
2017 Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, et al., 'Exercise management in type 1 diabetes: a consensus statement', The Lancet Diabetes and Endocrinology, 5 377-390 (2017) [C1]

© 2017 Elsevier Ltd Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of differ... [more]

© 2017 Elsevier Ltd Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of different forms of physical activity is particularly difficult for both the individual with type 1 diabetes and the health-care provider. People with type 1 diabetes tend to be at least as inactive as the general population, with a large percentage of individuals not maintaining a healthy body mass nor achieving the minimum amount of moderate to vigorous aerobic activity per week. Regular exercise can improve health and wellbeing, and can help individuals to achieve their target lipid profile, body composition, and fitness and glycaemic goals. However, several additional barriers to exercise can exist for a person with diabetes, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management. This Review provides an up-to-date consensus on exercise management for individuals with type 1 diabetes who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions.

DOI 10.1016/S2213-8587(17)30014-1
Citations Scopus - 39Web of Science - 22
2017 Lopez PE, Smart CE, McElduff P, Foskett DC, Price DA, Paterson MA, King BR, 'Optimizing the combination insulin bolus split for a high-fat, high-protein meal in children and adolescents using insulin pump therapy', Diabetic Medicine, 34 1380-1384 (2017) [C1]

© 2017 Diabetes UK Aims: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diab... [more]

© 2017 Diabetes UK Aims: To determine the optimum combination bolus split to maintain postprandial glycaemia with a high-fat and high-protein meal in young people with Type 1 diabetes. Methods: A total of 19 young people (mean age 12.9 ± 6.7 years) participated in a randomized, repeated-measures trial comparing postprandial glycaemic control across six study conditions after a high-fat and high-protein meal. A standard bolus and five different combination boluses were delivered over 2 h in the following splits: 70/30 = 70% standard /30% extended bolus; 60/40=60% standard/40% extended bolus; 50/50=50% standard/50% extended bolus; 40/60=40% standard/60% extended bolus; and 30/70=30% standard/70% extended bolus. Insulin dose was determined using the participant's optimized insulin:carbohydrate ratio. Continuous glucose monitoring was used to assess glucose excursions for 6 h after the test meal. Results: Standard bolus and combination boluses 70/30 and 60/40 controlled the glucose excursion up to 120 min. From 240 to 300 min after the meal, the glucose area under the curve was significantly lower for combination bolus 30/70 compared with standard bolus (P=0.004). Conclusions: High-fat and high-protein meals require a =60% insulin:carbohydrate ratio as a standard bolus to control the initial postprandial rise. Additional insulin at an insulin:carbohydrate ratio of up to 70% is needed in the extended bolus for a high fat and protein meal to prevent delayed hyperglycaemia.

DOI 10.1111/dme.13392
Co-authors Patrick Mcelduff, Bruce King
2016 Barnes RA, Wong T, Ross GP, Jalaludin BB, Wong VW, Smart CE, et al., 'A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus', Diabetologia, 59 2331-2338 (2016) [C1]

© 2016, Springer-Verlag Berlin Heidelberg. Aims/hypothesis: Identifying women with gestational diabetes mellitus who are more likely to require insulin therapy vs medical nutritio... [more]

© 2016, Springer-Verlag Berlin Heidelberg. Aims/hypothesis: Identifying women with gestational diabetes mellitus who are more likely to require insulin therapy vs medical nutrition therapy (MNT) alone would allow risk stratification and early triage to be incorporated into risk-based models of care. The aim of this study was to develop and validate a model to predict therapy type (MNT or MNT plus insulin [MNT+I]) for women with gestational diabetes mellitus (GDM). Methods: Analysis was performed of de-identified prospectively collected data (1992¿2015) from women diagnosed with GDM by criteria in place since 1991 and formally adopted and promulgated as part of the more detailed 1998 Australasian Diabetes in Pregnancy Society management guidelines. Clinically relevant variables predictive of insulin therapy by univariate analysis were dichotomised and included in a multivariable regression model. The model was tested in a separate clinic population. Results: In 3317 women, seven dichotomised significant independent predictors of insulin therapy were maternal age >30¿years, family history of diabetes, pre-pregnancy obesity (BMI =30¿kg/m2), prior GDM, early diagnosis of GDM (<24¿weeks gestation), fasting venous blood glucose level (=5.3¿mmol/l) and HbA1cat GDM diagnosis =5.5% (=37¿mmol/mol). The requirement for MNT+I could be estimated according to the number of predictors present: 85.7¿93.1% of women with 6¿7 predictors required MNT+I compared with 9.3¿14.7% of women with 0¿1 predictors. This model predicted the likelihood of several adverse outcomes, including Caesarean delivery, early delivery, large for gestational age and an abnormal postpartum OGTT. The model was validated in a separate clinic population. Conclusions/interpretation: This validated model has been shown to predict therapy type and the likelihood of several adverse perinatal outcomes in women with GDM.

DOI 10.1007/s00125-016-4047-8
Citations Scopus - 5Web of Science - 7
Co-authors Lesley Wicks, Clare Collins
2016 Anderson D, Phelan H, Jones K, Smart C, Oldmeadow C, King B, Crock P, 'Evaluation of a novel continuous glucose monitoring guided system for adjustment of insulin dosing¿¿¿PumpTune: a randomized controlled trial', Pediatric Diabetes, 17 478-482 (2016) [C1]

© 2015 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Ltd Objective: Retrospective continuous glucose monitoring (CGM) can guide insulin pump adjustments, howev... [more]

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Objective: Retrospective continuous glucose monitoring (CGM) can guide insulin pump adjustments, however, interpretation of data and recommending new pump settings is complex and subjective. We aimed to compare the safety and glycaemic profiles of children after their diabetologist or a novel algorithm (PumpTune) adjusted their insulin pump settings. Research design and methods: In a randomized cross-over trial of 22 patients aged 6¿14 yr with type 1 diabetes with mean Hba1c 7.4% (57 mmol/mol) using CSII, CGM was used over two periods each of 6.5 d to assess percentage time glucose remained within, above and below 3.9¿10.0 mmol/L. Before the start of one period pump settings were adjusted by the patient's diabetologist, and before the other insulin pump settings were adjusted by PumpTune. Results: A total of 63.4% of the sensor glucose levels were within target range with PumpTune settings and 57.4% were within range with the clinician settings (p = 0.016). The time spent above target range with PumpTune was 26.9% and with clinician settings was 33.5% (p = 0.021). The time spent below target range with PumpTune was 9.7% and with clinician settings was 9.2% (p = 0.77). The mean number of times when a sensor glucose level <2.75 mmol/L was recorded with PumpTune settings was 2.9 compared with 3.7 with clinician settings (p = 0.39). There were no serious adverse outcomes and no difference in parent-assessed satisfaction. Conclusions: Automated insulin pump adjustment with PumpTune is feasible and warrants testing in a larger more varied population over a longer time. In this well-controlled group of children, PumpTune achieved a more favorable glucose profile.

DOI 10.1111/pedi.12332
Citations Scopus - 2Web of Science - 1
Co-authors Bruce King, Christopher Oldmeadow
2016 Paterson MA, Smart CEM, Lopez PE, Mcelduff P, Attia J, Morbey C, King BR, 'Influence of dietary protein on postprandial blood glucose levels in individuals with Type¿1 diabetes mellitus using intensive insulin therapy', Diabetic Medicine, 33 592-598 (2016) [C1]

© 2016 Diabetes UK. Aim: To determine the effects of protein alone (independent of fat and carbohydrate) on postprandial glycaemia in individuals with Type¿1 diabetes mellitus usi... [more]

© 2016 Diabetes UK. Aim: To determine the effects of protein alone (independent of fat and carbohydrate) on postprandial glycaemia in individuals with Type¿1 diabetes mellitus using intensive insulin therapy. Methods: Participants with Type¿1 diabetes mellitus aged 7-40¿years consumed six 150¿ml whey isolate protein drinks [0¿g (control), 12.5, 25, 50, 75 and 100] and two 150¿ml glucose drinks (10 and 20¿g) without insulin, in randomized order over 8¿days, 4¿h after the evening meal. Continuous glucose monitoring was used to assess postprandial glycaemia. Results: Data were collected from 27 participants. Protein loads of 12.5 and 50¿g did not result in significant postprandial glycaemic excursions compared with control (water) throughout the 300¿min study period (P¿>¿0.05). Protein loads of 75 and 100¿g resulted in lower glycaemic excursions than control in the 60-120¿min postprandial interval, but higher excursions in the 180-300¿min interval. In comparison with 20¿g glucose, the large protein loads resulted in significantly delayed and sustained glucose excursions, commencing at 180¿min and continuing to 5¿h. Conclusions: Seventy-five grams or more of protein alone significantly increases postprandial glycaemia from 3 to 5¿h in people with Type¿1 diabetes mellitus using intensive insulin therapy. The glycaemic profiles resulting from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion. This research supports recommendations for insulin dosing for large amounts of protein.

DOI 10.1111/dme.13011
Citations Scopus - 11Web of Science - 13
Co-authors Bruce King, John Attia, Patrick Mcelduff
2015 Bell KJ, King BR, Shafat A, Smart CE, 'The relationship between carbohydrate and the mealtime insulin dose in type 1 diabetes', Journal of Diabetes and its Complications, 29 1323-1329 (2015) [C1]

© 2015 Elsevier Inc. All rights reserved. A primary focus of the nutritional management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount c... [more]

© 2015 Elsevier Inc. All rights reserved. A primary focus of the nutritional management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. Different methods exist to quantify carbohydrate including counting in one gram increments, 10 g portions or 15 g exchanges. Clinicians have assumed that counting in one gram increments is necessary to precisely dose insulin and optimize postprandial control. Carbohydrate estimations in portions or exchanges have been thought of as inadequate because they may result in less precise matching of insulin dose to carbohydrate amount. However, studies examining the impact of errors in carbohydrate quantification on postprandial glycemia challenge this commonly held view. In addition it has been found that a single mealtime bolus of insulin can cover a range of carbohydrate intake without deterioration in postprandial control. Furthermore, limitations exist in the accuracy of the nutrition information panel on a food label. This article reviews the relationship between carbohydrate quantity and insulin dose, highlighting limitations in the evidence for a linear association. These insights have significant implications for patient education and mealtime insulin dose calculations.

DOI 10.1016/j.jdiacomp.2015.08.014
Citations Scopus - 6Web of Science - 5
Co-authors Bruce King
2015 Paterson M, Bell KJ, O Connell SM, Smart CE, Shafat A, King B, 'The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management', Current Diabetes Reports, 15 (2015) [C1]

© 2015, The Author(s). A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the... [more]

© 2015, The Author(s). A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies.

DOI 10.1007/s11892-015-0630-5
Citations Scopus - 4Web of Science - 5
Co-authors Bruce King
2015 Smart C, '3.15 Nutritional management of diabetes in childhood', World Review of Nutrition and Dietetics, 113 218-225 (2015)
DOI 10.1159/000367863
Citations Scopus - 1
2015 Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA, 'Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era', DIABETES CARE, 38 1008-1015 (2015) [C1]
DOI 10.2337/dc15-0100
Citations Scopus - 67Web of Science - 59
Co-authors Bruce King
2014 Smart CE, Annan F, Bruno LPC, Higgins LA, Acerini CL, International Society for Pediatric and Adolescent Diabetes, 'ISPAD Clinical Practice Consensus Guidelines 2014. Nutritional management in children and adolescents with diabetes.', Pediatr Diabetes, 15 Suppl 20 135-153 (2014) [C1]
DOI 10.1111/pedi.12175
Citations Scopus - 43Web of Science - 34
2014 Lopez P, Smart C, Morbey C, McElduff P, Paterson M, King BR, 'Extended insulin boluses cannot control postprandial glycemia as well as a standard bolus in children and adults using insulin pump therapy.', BMJ Open Diabetes Research & Care, 2 1-6 (2014) [C1]
DOI 10.1136/bmjdrc-2014-000050
Citations Web of Science - 3
Co-authors Bruce King, Patrick Mcelduff
2013 Smart CEM, Evans M, O'Connell SM, McElduff P, Lopez PE, Jones TW, et al., 'Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive', DIABETES CARE, 36 3897-3902 (2013) [C1]
DOI 10.2337/dc13-1195
Citations Scopus - 52Web of Science - 46
Co-authors Patrick Mcelduff, Bruce King
2012 Smart CE, King BR, McElduff P, Collins CE, 'In children using intensive insulin therapy, a 20-g variation in carbohydrate amount significantly impacts on postprandial glycaemia', Diabetic Medicine, 29 E21-E24 (2012) [C1]
Citations Scopus - 26Web of Science - 20
Co-authors Clare Collins, Bruce King, Patrick Mcelduff
2011 Smart CE, Hopley LK, Burgess D, Collins CE, 'Biting off more than you can chew; is it possible to precisely count carbohydrate?', Nutrition & Dietetics, 68 227-230 (2011) [C1]
Citations Scopus - 2Web of Science - 1
Co-authors Clare Collins
2010 Barclay A, Gilbertson H, Marsh K, Smart CE, 'Dietary management in diabetes', Australian Family Physician, 39 579-583 (2010) [C2]
Citations Scopus - 7
2010 Smart CE, Ross K, Edge JA, King BR, McElduff P, Collins CE, 'Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks?', Diabetic Medicine, 27 348-353 (2010) [C1]
DOI 10.1111/j.1464-5491.2010.02945.x
Citations Scopus - 39Web of Science - 31
Co-authors Patrick Mcelduff, Clare Collins, Bruce King
2009 Smart C, Aslander-van Vliet E, Waldron S, 'Nutritional management in children and adolescents with diabetes', Pediatric Diabetes, 10 100-117 (2009)
DOI 10.1111/j.1399-5448.2009.00572.x
Citations Scopus - 64
2009 Smart CE, Ross K, Edge JA, Collins CE, Colyvas KJ, King BR, 'Children and adolescents on intensive insulin therapy maintain postprandial glycaemic control without precise carbohydrate counting', Diabetic Medicine, 26 279-285 (2009) [C1]
DOI 10.1111/j.1464-5491.2009.02669.x
Citations Scopus - 38Web of Science - 30
Co-authors Bruce King, Kim Colyvas, Clare Collins
2008 Smart CE, Collins CE, Schoonbeek J, 'Nutritional management of children and adolescents on insulin pump therapy: A survey of Australian practice', Pediatric Diabetes, 9 96-103 (2008) [C1]
DOI 10.1111/j.1399-5448.2007.00300.x
Citations Scopus - 2Web of Science - 2
Co-authors Clare Collins
2008 Ryan RL, King BR, Anderson DG, Attia JR, Collins CE, Smart CE, 'Influence of and optimal insulin therapy for a low-glycemic index meal in children with type 1 diabetes receiving intensive insulin therapy', Diabetes Care, 31 1485-1490 (2008) [C1]
DOI 10.2337/dc08-0331
Citations Scopus - 23Web of Science - 18
Co-authors Bruce King, John Attia, Clare Collins
2007 Aslander-van Vliet E, Smart C, Waldron S, 'Nutritional management in childhood and adolescent diabetes', Pediatric Diabetes, 8 323-339 (2007)

The nutritional care of children with diabetes is complex. Diabetes management is set within the context of the family, a surrounding social system, multiple carers, often deterio... [more]

The nutritional care of children with diabetes is complex. Diabetes management is set within the context of the family, a surrounding social system, multiple carers, often deteriorating national dietary characteristics, issues of non-compliance, peer pressure, emerging independence, and the ultimate aim of maintaining quality of life. It requires a deep understanding of the relationship between treatment regimens and constantly changing physiological requirements, including growth, fluctuations in appetite associated with changes in growth velocity, varying nutritional requirements, and sporadic episodes of physical activity. Nevertheless, evidence suggests that it is possible to improve diabetes outcomes through meticulous attention to nutritional management and an individualized approach to education. This requires a clear focus on dietary goals in relation to glycemic control and the reduction in cardiovascular risk. The fundamental premise of successful dietary outcomes is the development of a trusting relationship between the health professional, child, and carers, which facilitates behavior change during the challenges and turbulence of childhood and adolescent development. © 2007 The Authors Journal compilation © 2007 Blackwell Munksgaard.

DOI 10.1111/j.1399-5448.2007.00317.x
Citations Scopus - 44
2006 Nunn E, King B, Smart C, Anderson DG, 'A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes', Pediatric Diabetes, 7 254-259 (2006) [C1]
DOI 10.1111/j.1399-5448.2006.00200.x
Citations Scopus - 29Web of Science - 25
Co-authors Bruce King
2000 Krassie J, Smart C, Roberts DCK, 'A review of the nutritional needs of meals on wheels consumers and factors associated with the provision of an effective meals on wheels service-an Australian perspective', European Journal of Clinical Nutrition, 54 275-280 (2000)

Objective: A review of the literature was undertaken to identify the nutritional needs of elderly MOW consumers and factors affecting the ability of existing programs to meet thos... [more]

Objective: A review of the literature was undertaken to identify the nutritional needs of elderly MOW consumers and factors affecting the ability of existing programs to meet those needs. The focus was on the Australian experience but drawing on the world literature. Design: Keyword search of English language based computer databases of the medical and health literature. Results: Several studies suggest the nutritional intake of MOW consumers is below recommended levels, although the risk of nutritional deficiency has not always been identified. The literature indicates the effectiveness of Meals on Wheels programs are affected by a range of issues including the appropriateness of nutritional standards, menu selection, portion control, level of consumption and customer satisfaction. The literature recommends control of time and temperatures associated with food handling procedures, along with education of providers and customers, to assist in the provision of a safe food supply. Conclusions: Meals on Wheels is an important service, providing meals to housebound consumers. While the effectiveness of such programs is dependent on a range of variables, the nutritional impact of the service and the standard of food hygiene are fundamental assessment criteria.

DOI 10.1038/sj.ejcn.1600790
Citations Scopus - 18
Show 25 more journal articles

Conference (6 outputs)

Year Citation Altmetrics Link
2017 Marlow A, Rowe C, Anderson D, Wynne K, King BR, Smart CE, 'Children and young adults with type 1 diabetes are more overweight and obese than reference populations, and this worsens with age', Tasmania (2017)
Co-authors Bruce King, C Rowe
2016 Phan HV, Carrasco DS, Goodwin GC, Medioli AM, King BR, Smart C, Stephen C, 'A performance limitation for blood glucose regulation in type 1 diabetes accounting for insulin delivery delays', 2016 IEEE 55th Conference on Decision and Control, CDC 2016 (2016) [E1]

© 2016 IEEE. The usual recommendation made by clinicians to type 1 diabetics is that they should inject insulin when consuming a meal or, preferably, slightly earlier. However, in... [more]

© 2016 IEEE. The usual recommendation made by clinicians to type 1 diabetics is that they should inject insulin when consuming a meal or, preferably, slightly earlier. However, in practice, insulin injection maybe delayed. In this paper we develop a fundamental limit on performance when insulin is delivered at some time other than the preferred time. The paper develops an optimal injection policy which minimizes the maximum blood glucose response whilst ensuring that the minimum response does not fall below a pre-specified level. The result provides a 'gold standard' against which other insulin injection policies can be compared. Implementation issues are also briefly described.

DOI 10.1109/CDC.2016.7799036
Citations Scopus - 3
Co-authors Bruce King, Graham Goodwin
2013 O'Connell SM, Smart CE, Evans M, McElduff P, Lopez PE, Jones TW, et al., 'Both Protein and Fat Increase Postprandial Glucose Excursions in Children with Type 1 Diabetes and the Effect is Additive', IRISH JOURNAL OF MEDICAL SCIENCE (2013) [E3]
Co-authors Patrick Mcelduff, Bruce King
2009 Smart CE, Ross K, Edge J, Collins CE, King BR, 'Can children with Type 1 diabetes and their caregivers count carbohydrate accurately?', APEG Annual Scientific Meeting 2009. Abstracts, Coolum, QLD (2009) [E3]
Co-authors Clare Collins, Bruce King
2008 Smart CE, King B, Ross K, Edge J, Burgess D, Collins CE, 'Can children and adolescents with Type 1 diabetes on intensive insulin therapy count carbohydrate adequately enough to adjust premeal insulin?', Nutrition & Dietetics, Gold Coast, QLD (2008) [E3]
Co-authors Clare Collins
2008 Smart CE, Ross K, King BR, Edge JA, 'Can children with Type 1 diabetes and their carers count carbohydrate accurately?', 68th Scientific Session of the American Diabetes Association: Abstracts, San Francisco, CA (2008) [E3]
Co-authors Bruce King
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Grants and Funding

Summary

Number of grants 13
Total funding $953,711

Click on a grant title below to expand the full details for that specific grant.


20181 grants / $25,000

Defining the optimal insulin management for high fat and protein meals in children and young people with Type 1 Diabetes (T1D) using multiple daily insulin injection (MDI) therapy$25,000

Funding body: Australasian Paediatric Endocrine Group

Funding body Australasian Paediatric Endocrine Group
Project Team Doctor Carmel Smart
Scheme Project Grant
Role Lead
Funding Start 2018
Funding Finish 2018
GNo G1800885
Type Of Funding C3111 - Aust For profit
Category 3111
UON Y

20173 grants / $254,750

Hybrid Closed Loop Outpatient Trial$146,000

Funding body: Telethon Kids Institute

Funding body Telethon Kids Institute
Project Team Conjoint Associate Professor Bruce King, Doctor Carmel Smart, Associate Professor Timothy Jones, Associate Professor Elizabeth Davis, Doctor Martin deBock, Dr Jan Fairchild, Professor Geoffrey Ambler, Professor Fergus Cameron
Scheme Research Grant
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo G1700843
Type Of Funding C2210 - Aust StateTerritoryLocal - Own Purpose
Category 2210
UON Y

Rapid Calc Trial$70,000

Funding body: Menarini Diagnostics Limtied

Funding body Menarini Diagnostics Limtied
Project Team Conjoint Associate Professor Bruce King, Doctor Carmel Smart, Doctor Donald Anderson
Scheme Research Grant
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo G1701235
Type Of Funding C3211 - International For profit
Category 3211
UON Y

Improving glucose control and health outcomes for people with diabetes$38,750

Funding body: Lions Club

Funding body Lions Club
Project Team Conjoint Associate Professor Bruce King, Doctor Carmel Smart
Scheme Research Funding
Role Investigator
Funding Start 2017
Funding Finish 2018
GNo G1701451
Type Of Funding C3120 - Aust Philanthropy
Category 3120
UON Y

20163 grants / $290,660

Minimising Hypoglycaemia and Glycaemic Excursions induced by Food in Young People with Type 1 Diabetes Mellitus$215,660

Funding body: Juvenile Diabetes Research Foundation (JDRF)

Funding body Juvenile Diabetes Research Foundation (JDRF)
Project Team Doctor Carmel Smart, Conjoint Associate Professor Bruce King, Dr Elizabeth Davis
Scheme Type 1 Diabetes Clinical Research Network (T1DCRN)
Role Lead
Funding Start 2016
Funding Finish 2018
GNo G1600565
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y

In children and young people with type 1 diabetes and newly diagnosed coeliac disease, does commencement of a gluten-free diet improve daily glycaemic variability?$50,000

Funding body: Hunter New England Local Health District

Funding body Hunter New England Local Health District
Project Team Doctor Carmel Smart, Miss Prudence Lopez, Conjoint Associate Professor Bruce King
Scheme Research Funding
Role Lead
Funding Start 2016
Funding Finish 2016
GNo G1601083
Type Of Funding C3120 - Aust Philanthropy
Category 3120
UON Y

Establishment of an insulin dosing schedule for high fat, high protein meals in individuals with type 1 diabetes using insulin pump therapy$25,000

Funding body: Australasian Paediatric Endocrine Group

Funding body Australasian Paediatric Endocrine Group
Project Team Doctor Carmel Smart, Conjoint Associate Professor Bruce King
Scheme Project Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo G1601243
Type Of Funding C3120 - Aust Philanthropy
Category 3120
UON Y

20151 grants / $150,000

Evaluation of an Australian artificial pancreas algorithm for announced and unannounced meals$150,000

Funding body: Diabetes Australia

Funding body Diabetes Australia
Project Team Conjoint Associate Professor Bruce King, Emeritus Laureate Professor Graham Goodwin, Doctor Carmel Smart, Doctor Patrick McElduff, Ms Megan Paterson-Dick
Scheme Millennium Award
Role Investigator
Funding Start 2015
Funding Finish 2016
GNo G1401382
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y

20143 grants / $108,301

A comparison of three insulin dosage algorithms for meals of variable macronutrient composition on postprandial glucose levels in children with type 1 diabetes$55,264

Funding body: Australasian Paediatric Endocrine Group

Funding body Australasian Paediatric Endocrine Group
Project Team Doctor Carmel Smart, Conjoint Associate Professor Bruce King
Scheme Project Grant
Role Lead
Funding Start 2014
Funding Finish 2014
GNo G1301296
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

What is the optimal percentage of rapid and extended bolus insulin in a combination insulin bolus?$48,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Miss Prudence Lopez, Conjoint Associate Professor Bruce King, Doctor Carmel Smart
Scheme Project Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1400137
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

JDRF Travel Grant Award - American Diabetes Association in June in San Francisco$5,037

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Ms Megan Paterson-Dick, Conjoint Associate Professor Bruce King, Doctor Carmel Smart, Miss Prudence Lopez
Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo G1401497
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20121 grants / $100,000

The Gastronomic Lunch of the Year Fellowship$100,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Conjoint Associate Professor Bruce King, Dr Prudence Lopez, Doctor Carmel Smart, Dr Clare Morbey
Scheme Research Grant
Role Investigator
Funding Start 2012
Funding Finish 2014
GNo G1201044
Type Of Funding Contract - Aust Non Government
Category 3AFC
UON Y

20011 grants / $25,000

Acting on Overweight and Obesity in Hunter Children.$25,000

Funding body: John Hunter Children`s Hospital Research Foundation

Funding body John Hunter Children`s Hospital Research Foundation
Project Team Professor Clare Collins, Doctor Carmel Smart
Scheme Research Grant (Defunct)
Role Investigator
Funding Start 2001
Funding Finish 2001
GNo G0181224
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y
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Research Supervision

Number of supervisions

Completed0
Current7

Total current UON EFTSL

PhD1.53

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD Identifying an Insulin Dosing Strategy for Mixed Meals in Children and Young People with Type 1 Diabetes Using Multiple Daily Injection Therapy PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD Optimisation of Glycaemic Control During Exercise in Children with Type 1 Diabetes PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2017 PhD The Determinants of Overweight and Obesity in Children with Type 1 Diabetes PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2016 PhD Optimising Insulin Therapy For High Fat, High Protein Meal in People With Type 1 Diabetes Mellitus PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2015 PhD Effective Dietary Management of Gestational Diabetes Mellitus PhD (Nutrition & Dietetics), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2013 PhD Impact of Dietary Protein on Postprandial Blood Glucose Levels in Type 1 Diabetes Mellitus PhD (Medicine), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2012 PhD Reducing Acute Hyperglycaemia in Insulin Pump Therapy PhD (Paediatrics), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
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Dr Carmel Smart

Position

Conjoint Senior Lecturer
School of Health Sciences
Faculty of Health and Medicine

Contact Details

Email carmel.smart@newcastle.edu.au

Office

Room -
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