The Breakfast Rise, Education and Knowledge Study in Children and Young People who have Type 1 diabetes (T1D): The BREAK Study

Abstract

Background Children and Young People (CYP) with type 1 diabetes (T1D) often experience glucose variability (GV) and postprandial hyperglycaemia after breakfast. Aim The aim of the study was to describe glucose variability (GV) and to investigate postprandial glycaemia and the relationship with food composition following breakfast in CYP with T1D. Methods In an observational study, CYP with T1D were invited to share their continuous glucose monitoring (CGM) data and to submit seven-day questionnaires about their breakfast meal and the four-hour postprandial period. In a randomised crossover intervention CYP with T1D were invited to test the following breakfast meals twice: high glycaemic load (GL) (HGL meal), HGL with 10g of added protein (HGLP meal) and medium GL (MGL meal). Control meals were the participants usual breakfast. CGM data was collected for the three-hour postprandial period. Statistical analysis included t-tests and linear mixed models. A survey of dietitian’s experience of postprandial glucose after breakfast was also undertaken. Results 89 CYP were recruited to the observation study of which 74 submitted questionnaires. Diurnal GV (%CV) was significantly higher than nocturnal GV (38.1 ±4.3% vs. 36.4 ±5.2%, p<0.001). Data on 387 breakfast meals was analysed. Pre-prandial glucose was significantly higher for the multiple daily injection (MDI) users (9.5±2.9; 10.2±3.2 mmol/l) compared with insulin pump users (7.4±2.3; 8.8±2.5) (p<0.01). Pre-prandial glucose was significantly associated with the mean postprandial glucose (R2=0.27, p<0.001). Ingested meals which contained only breakfast cereals resulted in significantly higher glucose excursion at 30 (p<0.001), 60 (p<0.001) and 90 minutes (p=0.02) compared with meals which included a protein food. 25 CYP were recruited to the intervention study. At 30 and 60 minutes, the ingestion of the HGL meal resulted in a significantly higher glucose excursion compared with all other breakfast meals (p≤0.01). This remained significantly higher than after the ingestion of the HGLP meals at 90 and 120min (p<0.01). The results were comparable for those using Hybrid Closed Loops systems.