Endocrine Abstracts

Introduction: Despite an increasing incidence of adolescent type 2 diabetes mellitus (T2DM) with its associated morbidities and poor long-term prognosis, there remains uncertainty in its management. The National Institute for Health and Clinical Excellence (NICE) currently recommends initial lifestyle modifications alongside pharmacology management with metformin. Despite being shown to be effective in adults, little is known about the impact of lifestyle interventions, in particular dietary interventions, in adolescents with T2DM. The aim of this systematic review is to provide up-to-date evidence on the impact of dietary interventions in adolescents with T2DM to inform clinical practice.

Methods: The databases Embase, MEDLINE (via OVID), CENTRAL via Cochrane library, Web of Science and CINAHL were searched from January 2000 to May 2023 for studies involving dietary intervention in children under 19 years with T2DM. All study types were included. Titles and abstracts were screened, with 10% reviewer crossover, using Rayyan. All full-text articles and risk of bias assessments were assessed independently by two reviewers. The primary outcome was glycaemic control measured by HbA1C.

Results: Of 8352 search results, only four papers met inclusion criteria, with 28 children undergoing very low energy/calorie diets. Three studies were observational with two utilising matched controls, and the other a feasibility study in a small sample with no control group. No randomised control trials (RCTs) were identified. Results showed certain dietary interventions, such as carbohydrate counting and limiting high fat foods, achieved weight loss, significantly reduced HbA1C and beneficial changes to baseline pharmacological treatment. However, only one study reported longer term follow up and the effects on HbA1C were not sustained over 24 months, despite an improvement in BMI remaining.

Discussion: Our results show limited evidence, with a lack of robust clinical trials to support the effectiveness of dietary interventions in the management of T2DM in adolescence. Given the increasing incidence of adolescent T2DM, evidence of benefit in adulthood and encouraging short-term results from initial trials during adolescence, it is imperative that RCTs with larger sample sizes and longer term follow up are undertaken to determine the true effectiveness of dietary interventions on outcomes in adolescent T2DM.