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Recommendations Summary

T1DM: Nutrition Screening (2024)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    T1DM: Vitamin D Deficiency Screening

    In children and adolescents, we suggest screening for vitamin D deficiency at stage I type 1 diabetes (>=2 type 1 diabetes associated islet autoantibodies) or first onset of type 1 diabetes symptoms.

    Rating: Consensus
    Conditional

    T1DM: Screening for Associated Factors

    It is reasonable that health care professionals screen for disordered eating behaviors, food insecurity, housing stability/homelessness, health literacy, financial barriers, and social/community support and apply that information to treatment decisions.

    Rating: Consensus
    Conditional

    • Risks/Harms of Implementing This Recommendation

      No harms associated with the implementation of this recommendation. No obvious harms or risks associated with screening individuals for risk of eating disorders, vitamin D status or food insecurity issues. No significant cost may be associated with implementing this recommendation. Two recognized costs are the time and expense that may be required to train RDNs to perform the screening. However, most of the training materials are available in print or online and dietitians are typically familiar with these resources, or they are readily discoverable.

    • Conditions of Application

      Providers can follow guidance of their workplace on conducting the screening.

    • Potential Costs Associated with Application

      Time and cost may be necessary to train RDNs to conduct this screening. Additional costs will vary according to insurance coverage.

    • Recommendation Narrative

      Evidence also indicates that vitamin D deficiency is prevalent among all youth in the U.S., including those with T1DM. In children and adolescents (6-19 years old) living with T1DM, vitamin D insufficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] concentrations of 30 - 50 nmol/L or 12 - 20 ng/mL) and/or deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] concentrations of <30 nmol/L or <12 ng/mL) are common, affecting as many as 63% of patients. Vitamin D supplementation repletes vitamin deficiency but given the notably suboptimal glycemic management among children and adolescents with T1DM, understanding the role of vitamin D supplementation on A1C is imperative. Recent evidence states that vitamin D can protect pancreatic beta cells and hence might help with achieving glycemic targets. Hence, screening individuals with T1DM for vitamin D status can be helpful.

    • Recommendation Strength Rationale

      This recommendation is based on expert panel's Consensus.

    • Minority Opinions

      None.