2021 |
Smith TA, Smart CE, Fuery MEJ, Howley PP, Knight BA, Harris M, King BR, 'In Children and Young people with type 1 Diabetes using Pump Therapy an additional 40% of the Insulin dose for a High fat, High Protein breakfast improves postprandial glycaemic excursions: A cross- over trial.', Diabet Med, e14511 (2021)
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2021 |
Smith TA, Smart CE, Howley PP, Lopez PE, King BR, 'For a high fat- high protein breakfast, preprandial administration of 125% of the insulin dose improves postprandial glycaemic excursions in people with Type 1 diabetes using multiple daily injections: a cross-over trial.', Diabet Med, e14512 (2021)
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2020 |
Lawrence C, Seckold R, Smart C, King BR, Howley P, Feltrin R, et al., 'Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID-19 pandemic', Diabetic Medicine, (2020)
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2020 |
Smith TA, Blowes AA, King BR, Howley PP, Smart CE, 'Families' reports of problematic foods, management strategies and continuous glucose monitoring in type 1 diabetes: A cross-sectional study', Nutrition & Dietetics, (2020)
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2020 |
Goodwin GC, Seron MM, Medioli AM, Smith T, King BR, Smart CE, 'A systematic stochastic design strategy achieving an optimal tradeoff between peak BGL and probability of hypoglycaemic events for individuals having type 1 diabetes mellitus', Biomedical Signal Processing and Control, 57 (2020) [C1]
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2020 |
Deeb A, Elbarbary N, Smart CE, Beshyah SA, Habeb A, Kalra S, et al., 'ISPAD Clinical Practice Consensus Guidelines: Fasting during Ramadan by young people with diabetes', Pediatric Diabetes, 21 5-17 (2020) [C1]
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2020 |
Pursey KM, Hart M, Jenkins L, McEvoy M, Smart CE, 'Screening and identification of disordered eating in people with type 1 diabetes: A systematic review', JOURNAL OF DIABETES AND ITS COMPLICATIONS, 34 (2020) [C1]
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2020 |
Hart M, Pursey K, Smart C, 'Low carbohydrate diets in eating disorders and type 1 diabetes', Clinical Child Psychology and Psychiatry, (2020)
© The Author(s) 2020. Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of ... [more]
© The Author(s) 2020. Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of both conditions involves encouraging a wide variety of healthful foods in the context of usual cultural and family traditions. In recent times, low carbohydrate diets have seen a rise in popularity, both in T1D and in the general population. Low carbohydrate diets involve dietary restriction, although the extent depends on the level of carbohydrate prescription. Although dietary restriction is a known risk factor for eating disorders, there is limited literature on the impact of following a low carbohydrate diet on the development and maintenance of eating disorders in T1D. The aim of this review is to discuss the impact of dietary restriction on the development and treatment of eating disorders and propose considerations to enable optimum health outcomes in individuals with T1D, an at risk group. In order to achieve this, clarity regarding strategies that allow both flexibility in dietary intake and facilitate healthy eating behaviours, whilst achieving glycaemic targets, are required.
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2020 |
Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, et al., 'Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)', DIABETOLOGIA, 63 2501-2520 (2020)
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2020 |
Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, et al., 'Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)', Pediatric Diabetes, 21 1375-1393 (2020) [C1]
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2020 |
Barnes RA, Wong T, Ross GP, Griffiths MM, Smart CE, Collins CE, et al., 'Excessive weight gain before and during gestational diabetes mellitus management: What is the impact?', Diabetes Care, 43 74-81 (2020) [C1]
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2020 |
Smart CEM, King BR, Lopez PE, 'Insulin Dosing for Fat and Protein: Is it Time?', DIABETES CARE, 43 13-15 (2020)
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2020 |
Paterson MA, Smart CEM, Howley P, Price DA, Foskett DC, King BR, 'High-protein meals require 30% additional insulin to prevent delayed postprandial hyperglycaemia', Diabetic Medicine, 37 1185-1191 (2020) [C1]
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2019 |
Seckold R, Howley P, King BR, Bell K, Smith A, Smart CE, 'Dietary intake and eating patterns of young children with type 1 diabetes achieving glycemic targets', BMJ Open Diabetes Research and Care, 7 1-7 (2019) [C1]
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2019 |
Seckold R, Fisher E, de Bock M, King BR, Smart CE, 'The ups and downs of low-carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes', Diabetic Medicine, 36 326-334 (2019) [C1]
© 2018 Diabetes UK Abstract: Dietary management has been a mainstay of care in Type 1 diabetes since before the discovery of insulin when severe carbohydrate restriction was advoc... [more]
© 2018 Diabetes UK Abstract: Dietary management has been a mainstay of care in Type 1 diabetes since before the discovery of insulin when severe carbohydrate restriction was advocated. The use of insulin facilitated re-introduction of carbohydrate into the diet. Current management guidelines focus on a healthy and varied diet with consideration of glycaemic load, protein and fat. As a result of frustration with glycaemic outcomes, low-carbohydrate diets have seen a resurgence in popularity. To date, low-carbohydrate diets have not been well studied in the management of Type 1 diabetes. Studies looking at glycaemic outcomes from low-carbohydrate diets have largely been cross-sectional, without validated dietary data and with a lack of control groups. The participants have been highly motivated self-selected individuals who follow intensive insulin management practices, including frequent blood glucose monitoring and additional insulin corrections with tight glycaemic targets. These confounders limit the ability to determine the extent of the impact of dietary carbohydrate restriction on glycaemic outcomes. Carbohydrate-containing foods including grains, fruit and milk are important sources of nutrients. Hence, low-carbohydrate diets require attention to vitamin and energy intake to avoid micronutrient deficiencies and growth issues. Adherence to restricted diets is challenging and can have an impact on social normalcy. In individuals with Type 1 diabetes, adverse health risks such as diabetic ketoacidosis, hypoglycaemia, dyslipidaemia and glycogen depletion remain clinical concerns. In the present paper, we review studies published to date and provide clinical recommendations for ongoing monitoring and support for individuals who choose to adopt a low-carbohydrate diet. Strategies to optimize postprandial glycaemia without carbohydrate restriction are presented.
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2019 |
Evans M, Smart CEM, Paramalingam N, Smith GJ, Jones TW, King BR, Davis EA, 'Dietary protein affects both the dose and pattern of insulin delivery required to achieve postprandial euglycaemia in Type 1 diabetes: a randomized trial.', Diabetic medicine : a journal of the British Diabetic Association, 36 499-504 (2019) [C1]
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2019 |
Paterson MA, King BR, Smart CEM, Smith T, Rafferty J, Lopez PE, 'Impact of dietary protein on postprandial glycaemic control and insulin requirements in Type 1 diabetes: a systematic review', Diabetic Medicine, 36 1585-1599 (2019) [C1]
© 2019 Diabetes UK Aim: Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribut... [more]
© 2019 Diabetes UK Aim: Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribute to postprandial glycaemic excursions with recommendations to consider protein when calculating mealtime insulin doses. The aim of this review is to identify and synthesize evidence about the glycaemic impact of dietary protein and insulin requirements for individuals with Type 1 diabetes. Methods: A systematic literature search of relevant biomedical databases was performed to identify research on the glycaemic impact of dietary protein when consumed alone, and in combination with other macronutrients in individuals with Type 1 diabetes. Results: The review included 14 published studies dated from 1992 to 2018, and included studies that researched the impact of protein alone (n¿=¿2) and protein in a mixed meal (n¿=¿12). When protein was consumed alone a glycaemic effect was not seen until =¿75¿g. In a carbohydrate-containing meal =¿12.5¿g of protein impacted the postprandial glucose. Inclusion of fat in a high-protein meal enhanced the glycaemic response and further increased insulin requirements. The timing of the glycaemic effect from dietary protein ranged from 90 to 240¿min. Studies indicate that the postprandial glycaemic response and insulin requirements for protein are different when protein is consumed alone or with carbohydrate and/or fat. Conclusions: This systematic review provides evidence that dietary protein contributes to postprandial glycaemic excursions and insulin requirements. These insights have important implications for the education of people with Type 1 diabetes and highlights the need for more effective insulin dosing strategies for mixed macronutrient meals.
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2019 |
Marlow AL, Rowe CW, Anderson D, Wynne K, King BR, Howley P, Smart CE, 'Young children, adolescent girls and women with type 1 diabetes are more overweight and obese than reference populations, and this is associated with increased cardiovascular risk factors.', Diabetic medicine : a journal of the British Diabetic Association, 36 1487-1493 (2019) [C1]
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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', Diabetic Medicine, 35 1440-1447 (2018) [C1]
© 2018 Diabetes UK Aim: To compare systematically the impact of two novel insulin-dosing algorithms (the Pankowska Equation and the Food Insulin Index) with carbohydrate counting ... [more]
© 2018 Diabetes UK Aim: To compare systematically the impact of two novel insulin-dosing algorithms (the Pankowska Equation and the Food Insulin Index) with carbohydrate counting on postprandial glucose excursions following a high fat and a high protein meal. Methods: A randomized, crossover trial at two Paediatric Diabetes centres was conducted. On each day, participants consumed a high protein or high fat meal with similar carbohydrate amounts. Insulin was delivered according to carbohydrate counting, the Pankowska Equation or the Food Insulin Index. Subjects fasted for 5 h following the test meal and physical activity was standardized. Postprandial glycaemia was measured for 300 min using continuous glucose monitoring. Results: 33 children participated in the study. When compared to carbohydrate counting, the Pankowska Equation resulted in lower glycaemic excursion for 90¿240 min after the high protein meal (p < 0.05) and lower peak glycaemic excursion (p < 0.05). The risk of hypoglycaemia was significantly lower for carbohydrate counting and the Food Insulin Index compared to the Pankowska Equation (OR 0.76 carbohydrate counting vs. the Pankowska Equation and 0.81 the Food Insulin Index vs. the Pankowska Equation). There was no significant difference in glycaemic excursions when carbohydrate counting was compared to the Food Insulin Index. Conclusion: The Pankowska Equation resulted in reduced postprandial hyperglycaemia at the expense of an increase in hypoglycaemia. There were no significant differences when carbohydrate counting was compared to the Food Insulin Index. Further research is required to optimize prandial insulin dosing.
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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.
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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 HbA1c declined 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.
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2018 |
Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, et al., 'ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents', PEDIATRIC DIABETES, 19 75-83 (2018)
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2018 |
Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL, 'ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes.', Pediatric diabetes, 19 Suppl 27 136-154 (2018) [C1]
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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.
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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]
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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.
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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.
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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 HbA1c at 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.
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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 & Sons A/S. Published by John Wiley & 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.
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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.
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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.
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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.
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2015 |
Smart C, '3.15 Nutritional management of diabetes in childhood', World Review of Nutrition and Dietetics, 113 218-225 (2015)
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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]
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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]
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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]
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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]
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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]
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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]
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2010 |
Barclay A, Gilbertson H, Marsh K, Smart CE, 'Dietary management in diabetes', Australian Family Physician, 39 579-583 (2010) [C2]
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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]
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2009 |
Smart C, Aslander-van Vliet E, Waldron S, 'Nutritional management in children and adolescents with diabetes', Pediatric Diabetes, 10 100-117 (2009)
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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]
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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]
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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]
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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.
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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]
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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.
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