P-470: Glycemic control, body composition, and mediterranean diet adherence in pediatric type 1 diabetes
F Yavuzyılmaz Şimşek, H Tan, M Ç Karataş, S Akbel, Ö Tekin, F B Özdemir, A Güç, Z Erdem, Ö Köprülü, İ M Erbaş, H A Korkmaz, Ö Nalbantoğlu, B ÖzkanAbstract
Introduction
Glycemic control in pediatric type 1 diabetes mellitus (T1DM) remains suboptimal despite advances in care. We evaluated associations between CGM-derived metrics, body composition, and Mediterranean diet adherence.
Objectives
To identify determinants of glycemic control using CGM-derived metrics and to examine the contribution of body composition and Mediterranean diet adherence in pediatric T1DM.
Methods
In this cross-sectional study, children and adolescents with T1DM were assessed using HbA1c, Time in Range (TIR), Glycemia Risk Index (GRI), and hyperglycemia burden (CHyper). Body composition (bioimpedance) and BMI-SDS were analyzed. Mediterranean diet adherence was assessed using KIDMED. Multivariable regression identified predictors of HbA1c and body fat.
Results
A total of 109 children and adolescents with type 1 diabetes were included in the study. Mean age was 12.7±3.4 years; 72% were pubertal; 95% used multiple daily injections. Mean HbA1c was 8.06±1.53%, with 24% achieving target (<7%). Mean TIR was 52.5±17.1%, and 22% reached ≥70%. Mean GRI was 60.2±28.5; 24% were in the highest risk category. Mediterranean diet adherence was low (15%), moderate (42%), and high (40%), consistent with our region. Poor control (HbA1c ≥9%) was associated with older age and higher CHyper. In multivariable analysis, CHyper independently predicted HbA1c (p<0.001). BMI-SDS was the main determinant of body fat (β=4.81, p<0.001; R2=0.36) and correlated moderately with fat percentage (r=0.58). Discordant phenotypes (normal BMI-SDS with high fat) showed numerically higher GRI and CHyper. KIDMED was not associated with glycemic metrics but higher adherence was linked to lower LDL (p=0.020)
Conclusions
Glycemic control remains suboptimal in this cohort. Hyperglycemia burden is the main determinant of HbA1c. BMI-SDS does not fully reflect adiposity, and discordant phenotypes may carry additional risk. Mediterranean diet adherence was not associated with glycemic control but may confer lipid benefits.