Prescribed versus unrestricted carbohydrate diets in children with type 1 diabetes

The diets of 53 children over 8 years of age with diabetes mellitus were examined by 24 h recall. Thirty-seven had been on prescribed carbohydrate diets while 16 had been on an unrestricted carbohydrate diet since diagnosis. The mean intakes of energy (prescribed 9.1 MJ, unrestricted 9.0 MJ, p = 0.66), carbohydrate (prescribed 259 g, unrestricted 251 g, p = 0.64), fat (prescribed 99.8 g, unrestricted 98.2 g, p = 0.84) and fibre (prescribed 29.2 g, unrestricted 31.0 g, p = 0.42) were not significantly different between the two groups. Both groups showed similar distribution of carbohydrate through the day and considerable day to day variation in their carbohydrate intake (coefficient of variation, prescribed 14.5%, unrestricted 14.1%, p = 0.87). Those on prescribed diet had a mean carbohydrate intake which exceeded their prescription by 36%. Both groups had above average fibre intake suggesting that qualitative advice was being followed. There were no significant differences between the two groups in metabolic control (HbA1 prescribed 12.4%, unrestricted 11.9%, p = 0.23), body mass index (prescribed 19.8 kg m-2, unrestricted 20.4 kg m-2) or insulin dosage (prescribed 1 unit kg-1 day-1, unrestricted 0.9 units kg-1 day-1). This study has shown no differences between prescribed and unrestricted carbohydrate diets. Qualitative, rather than quantitative advice may be more appropriate in the management of Type 1 diabetic children.