Poor outcomes in Australian teenagers with T1

[nickm]

Most Oz T1s have ready access to specialist medical and dietary advice, yet the Medical Journal of Australia recently reported very high levels of obesity in teenage T1s. Higher than the general population, and higher than historical levels. And low numbers reaching HbA1c targets.
The current liberal diet philosophy is a total disaster.
T1s need to be informed of the poor outcomes of a DAFNE type approach, compared to other methods.

 

[Crystalwand]

Please explain more, I been on the Dafne, is it all ****, ?

 

[leslie10152]

Please explain more, I been on the Dafne, is it all ****, ?

It is very difficult to nail down a specific process that suits all individuals. The variables of human genetics is extraordinary, you can't simply group everyone into a set of standards. Every diabetic I speak to has a particular variable to their condition which does not match others. No one indivudual has the key to perfect control. We just have to find the perfect medium for each individual need. A team effort if you will.

 

[Scott-C]

Is it this report you're talking about?
https://www.mja.com.au/journal/2017...first-national-audit-children-and-adolescents

It's a bit of a leap to say that because 33% of T1 Oz youth are overweight and only 27% meet targets that DAFNE/ liberal attitudes is to blame. By the way, the 33% compares to 27% in the general population and I'm not aware of any non-Ts doing DAFNE, so it's much more likely to be external factors.

Quite apart from the fact that not all T1s have done DAFNE, teenagers are teenagers: you could send a lot of them on any course you like, DAFNE, keto, paleo, lchf, the chances of them all sticking to it are minimal - teens do what they want. How many teens do you know who say, nah, I can't do that because my nurse told me not to?

Let's be blunt about this: some people are overweight because they eat too much. It's nothing to do with evil carbs. It's not what you eat, it's how much, and knowing when to stop. If I put my mind to it, I could end up overweight on a nil carb diet if I ate too much bacon.

I regularly eat carbs and have done so since dx almost thirty years ago. Give or take a few kilos, I've been the same weight all that time, BMI is 25, a1c is 36, AGP graph from libre is reassuringly tight, yet paleo/keto/lchf people will still say, ooh, pasta, you're taking risks there, mate! No I'm not, because I know to stop eating when I'm full.

I found the DAFNE course very useful. At no stage was there any sense that I was being told I had to eat carbs. It merely provided methods for calculating bolus for those who choose to do so. If people then head out the door to the nearest McDonalds for lunch, then hit the pub, then a pizza on the way home, that can't be laid at the door of DAFNE.

 

[phoenix]

Just to add to the above, DAFNE is for adults , aged over 18 so we don't have any evidence that it is this approach that is causing the problems.

: you could send a lot of them on any course you like, DAFNE, keto, paleo, lchf, the chances of them all sticking to it are minimal - teens do what they want. How many teens do you know who say, nah, I can't do that because my nurse told me not to?

I think Scott's answer above, added to the normal hormonal, and weight changes during adolescence which play havoc with insulin requirements are far more likely to be the reasons.
Of course there is the other side of the spectrum; the number of young T1s who withhold insulin in order to stay thin, without having to count/weigh/restrict food; just like their friends. Very tempting especially if a lot of weight was lost before diagnosis. The poor HCPs have to tread between the devil and the deep blue sea when advising their young patients.

Advising teenagers, either as their doctors or their parents is a task I really wouldn't want to have.