# Education Practices of Dietitians Across Australia and New Zealand Around the Glycaemic Management of Dietary Fat and Protein in Type 1 Diabetes and the Use of Continuous Glucose Monitoring: A Survey Evaluation

## TL;DR

Dietitians in Australia and New Zealand are not consistently following guidelines to educate families on managing dietary fat and protein in children with type 1 diabetes, despite using continuous glucose monitoring.

## Contribution

This study evaluates current dietitian practices in Australia and New Zealand regarding glycaemic education and CGM use for type 1 diabetes management.

## Key findings

- Only 10% of dietitians provided full education and insulin strategies for managing fat and protein as recommended.
- CGM is widely used (90%) to guide insulin adjustments and education.
- Barriers include lack of procedures, resources, time, and family interest or overwhelm.

## Abstract

Background/Objectives: International guidelines recommend that all children and adolescents with type 1 diabetes (T1D) receive education on the glycaemic impact of fat and protein from diagnosis. In addition, the insulin strategy should be adjusted to compensate for fat and protein excursions. Data from continuous glucose monitoring (CGM) can guide insulin adjustment. This study sought to determine whether the current practices of dietitians in Australia and New Zealand align with guidelines. Methods: An anonymous, online survey of paediatric T1D dietitians working in tertiary centres (n = 20; Australia, n = 14, New Zealand, n = 6) was undertaken from February to March 2023. The Australian and New Zealand Society for Paediatric Endocrinology and Diabetes (ANZSPED) disseminated the survey link. The questionnaire covered three content domains: demographic information about the clinic and practitioner, the health professionals’ education practices regarding fat and protein, and the use of CGM. Results: This pilot study had a 100% response rate, with a dietitian representative from all eligible centres responding on behalf of the diabetes team. Only 10% (n = 2) of respondents both (i) provided education on the glycaemic impact of fat and protein to all families at diagnosis and (ii) always provided insulin strategies to manage fat and protein where it impacted glycemia, as per guidelines. Barriers to education included a lack of procedure (47%, n = 7), consumer resources (40%, n = 6), and time (33%, n = 5). Reasons for not recommending strategies to manage fat and protein were perceptions that the family was overwhelmed (100%, n = 10) or not interested (60%, n = 6), and uncertainty of the best strategy (40%, n = 4). CGM was used by “almost all” respondents to educate and adjust the insulin strategy (90%, n = 18). Conclusions: Most dietitians surveyed were not consistently providing fat and protein education and management strategies to children with T1D in line with guidelines. CGM is a key tool routinely used by dietitians in nutrition education to help guide insulin adjustment. Dietitians need greater support through educational resources for families and training in evidence-based strategies to manage deglycation from dietary fat and protein to align with guidelines.