Nutrition and Healthy Lifestyles for Children and Adolescents with Early-Stage Type 1 Diabetes

BACKGROUND: Increasingly, children and adolescents are being identified in early-stage type 1 diabetes (T1D), defined as two or more islet autoantibodies without hyperglycemia (above diagnostic threshold) or reliance on intensive insulin therapy. They require clinical monitoring and care. Healthy lifestyle education is recommended in guidelines; however, evidence synthesis to inform clinical practice is lacking. Therefore, this review summarizes current evidence on nutrition, lifestyle to delay progression to stage 3 T1D and proposes lifestyle strategies for children and adolescents with early-stage T1D. SUMMARY: Specifically, we suggest a key focus on reducing beta-cell stress, promoting a healthy gut microbiome and establishing healthy lifestyles and relationships with food, prior to the introduction of intensive insulin therapy. As secondary prevention of T1D is an emerging research area and randomized controlled trials are scarce, evidence has been largely drawn from prospective cohort studies and routine clinical care for stage 3 T1D. KEY MESSAGES: A balanced and varied diet, limiting intake of foods containing high amounts of saturated fat and added sugar, and moderate levels of physical activity are likely beneficial for overall health in children and adolescents with early-stage T1D. Low glycemic index diets may be protective against progression to stage 3 T1D.