Description

Introduction: Type 1 diabetes occurs when the pancreas cannot produce insulin and a person must be given insulin exogenously. Managing this health condition involves strict diet planning including carbohydrate counting (i.e. identifying and counting carbohydrates to match insulin dose). In addition, to high food management burden, frequent bodyweight monitoring, and weight gain related to insulin usage, makes people living with type 1 diabetes more susceptible to disordered eating behaviours (like intentional food restriction), compared to those without. Automated insulin delivery systems (AID), which automatically adjusts insulin as a response to continuously measured blood glucose levels has shown to improve quality of life, and improve glycemic levels, however it's impact on eating behaviours and diet is unknown. There is also a need to determine the carbohydrate counting inaccuracy threshold to maintain glycemic stability depending on the type of delivery system used (AID vs. Not).

Objectives

1. Determine the relationship between AID and eating behaviours
2. Determine the carbohydrate counting inaccuracy threshold to maintain glycemic stability and understand whether AID use modifies this relationship.

Methods: This is an observational cross-section analysis of people with type 1 diabetes.

Eligibility criteria included: those living with type 1 diabetes for more than 1 year, using at least 2 insulin injections per day or using an insulin pump, who were living in Canada, 12 years of age or older, and using their current insulin delivery system for 3 months or more.

Participants are excluded if they were pregnant/currently breastfeeding and did not speak English or French.

Demographic, and diabetes-related information (including AID use), are determined through an initial questionnaire, which takes about 15 minutes to complete. Disordered eating behaviours were determined through validated questionnaires. The Three Factor Eating Questionnaire (TFEQR-21) identified behaviours such as cognitive restraint (score ranged from 6 to 24), emotional eating (score ranged from 6 to 24), and uncontrolled eating (score ranged from 9 to 36). The Diabetes Eating Problem Survey Revised (DEPS-R) identified DEBs specific to diabetes (score ranged from 0 to 80 with \> 20 representing those at risk of DEB). The Teruel Orthorexia Scale (TOS) identified orthorexia nervosa behaviours defined as an obsession with healthy eating which may lead to emotional impairments (score ranged from 0 to 24).

Dietary intake information will be collected through a 4 day picture food journal (3 weekdays and 1 weekend) application called Keenoa and analyzed by a Registered Dietitian.

Glycemic outcomes such as glucose time in range (TIR), which measures the amount of time glucose levels are between 3.9-10.0mmol/L, and Coefficient Variation, were reported through a 14 day CGM report (Clarity, Dexcom, Medtronic).

Physical activity will be measured through an Actigraph GT3X for 8 days.

Descriptive analysis will be completed at enrollment, to determine the mean (SD) socio-demographic information, eating behaviour scores and dietary intake (macro/micronutrient profile) by insulin delivery system (AID and injections/insulin pumps).

Multivariate linear regression will be used to determine the relationship between AID compared to injections/insulin pumps and disordered eating behaviour scores.

Secondly, carbohydrate counting inaccuracy will be determined by comparing participant reported carbohydrate counts measured in mean (SD) grams per meal to RD measured carbohydrate counts by analyzing 4-day dietary reports, as generated by Keenoa.

Carbohydrate counting inaccuracy threshold will be determined through multivariate linear regression by exploring the relationship between percent carbohydrate counting inaccuracy and % of glucose Time in Range and Coefficient Variation. Type of insulin delivery will be used as an effect modifier to determine how this relationship is modified by AID and injections/insulin pumps.