P-344: Lifestyle medicine in pediatric type 1 diabetes: a scoping review of the six pillars as adjunct therapy
N Olivares, S OlivaresAbstract
Introduction
Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood. Intensive insulin therapy is the mainstay of treatment, with targets of time-in-range (TIR) >70% and HbA1c ≤7.0% (≤6.5% with advanced technology). Evidence on the six pillars of lifestyle medicine (LM) in T1D comes mostly from adults or from pillars analyzed individually, revealing a gap in integrated pediatric data.
Objectives
To identify and characterize available evidence on the adjunct role of the six LM pillars alongside insulin therapy in pediatric T1D, and determine current knowledge gaps.
Methods
A structured literature search was conducted for studies published between 2006 and 2026 in PubMed, Web of Science, and Scopus using combined descriptors for pediatric T1D and LM pillars, following PRISMA-ScR criteria. We included 210 articles (trials, observational, qualitative, systematic reviews, meta-analyses, and guidelines). Studies exclusively in adults or other diabetes types were excluded.
Results
Nutrition and physical activity show the most consistent association with optimized HbA1c and TIR; cardiorespiratory fitness associates more robustly than self-reported activity. Restorative sleep directly correlates with glycemic stability and executive function. Childhood-onset T1D carries higher psychiatric risk; mindfulness and family/school support are linked to lower HbA1c, greater self-efficacy, and quality of life. Psychological distress links to disordered eating and higher HbA1c. Avoiding alcohol and tobacco is linked to better metabolic profile and lower complication risk.
Conclusions
Available evidence suggests LM, via quality diet, regular exercise, restorative sleep, stress management, positive social connections, and avoiding toxic substances, tends to act synergistically with insulin therapy, associated with better glycemic control and well-being in pediatric T1D. Further primary research addressing all six pillars with higher-quality designs is warranted.