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Objective To review the dietary intake of children and adolescents with type 1 diabetes Mellitus and its association with the glycemic profile. Methods Longitudinal observational study. Dietary intake was measured using a three-day dietary record and the glycemic profile with a continuous glucose monitoring (range between 70 and 180mg/dL) and serum glycated hemoglobin levels (ideal <7.5%). Anthropometric data, insulin therapy, and carbohydrate counting were collected. Results The sample included 34 individuals with type 1 diabetes Mellitus aged 13.6±2.1 years. The majority of the population was eutrophic (76.4%). The entire sample used the basal-bolus insulin regimen, with mean insulin dose of 1.0±0.2U/kg/day; for 44.1% of the sample the carbohydrate counting method was used. Macronutrients intake was adequate in only 8.8% of the individuals, the highest frequency of inadequacy was related to carbohydrates (p=0.07). Inadequate glycemic control with hyperglycemia episodes and high mean glycated hemoglobin (9.7%) was observed in all individuals (61.3±18.5%). Carbohydrate counting was responsible for maintaining the percentage of time that the patient had interstitial blood glucose values within the range >40% (p<0.001) and maintaining the percentage of time in hyperglycemia <50% (p<0.001). Conclusion The majority of individuals were eutrophic, but presented inadequate dietary intake and glycemic control. The method of counting carbohydrates positively influenced the glycemic profile.

Introdução: Diabetes mellitus tipo 1 (DM1) é uma doença cujo controle é desafiador, incluindo os cuidados na escola. Objetivo: Avaliar o comportamento e identificar problemas no ambiente escolar. Métodos: Estudo transversal com aplicação de questionário aos pacientes e cuidadores atendidos em serviço de endocrinopediatria. Resultados: Foram avaliados 129 pacientes, 114 do ensino fundamental/médio (EFM) e 15 da educação infantil (EI), com medianas de idade de 11 anos (2-17 anos) e de tempo de doença de 4 anos (0,2-14 anos). Entre os alunos do EFM, 40% aplicavam insulina na escola, entre eles 20% aplicavam no banheiro, 69,6% usavam caneta e apenas um, seringa (p<0,001). A hemoglobina glicada foi maior entre os que já haviam reprovado na escola (p<0,01). A maior parte (93,9%) lanchava na escola, apenas 37,7% recebiam lanche para DM1, mais frequente na escola municipal (p<0,001). Em relação à hipoglicemia, 78,1% já apresentaram pelo menos um episódio na escola, 63,2% relataram que os professores não conheciam o tratamento, 39,5% não levavam glicosímetro para escola, 16,7% mediam a glicemia antes da educação física e 51,7% sentiam medo de passar mal na escola. Dos alunos da EI, 66,7% recebiam insulina na escola. Apenas 2 pacientes tinham glucagon na escola para hipoglicemia grave. Conclusão: Observou-se despreparo das instituições para aplicação de insulina, fornecimento de cardápio individualizado, e para urgências que demandam assistência imediata como hipoglicemia. As dificuldades de controle do DM1 na escola justificam a necessidade de desenvolver estratégias que promovam melhor qualidade de vida no ambiente escolar aos portadores de DM1. Palavras-chave: Diabetes Mellitus Tipo 1. Comportamento. Serviços de Saúde Escolar.

INTRODUCTION: Cardiovascular diseases are the main cause of death in patients with type 1 diabetes mellitus (T1DM) and atherosclerotic process begins in childhood. OBJECTIVE: To evaluate lipid profile of patients with T1DM accompanied at the pediatric endocrinology (UEP), Hospital de Clínicas, Federal University of Paraná (HC-UFPR), the prevalence of dyslipidemia and its correlation with glycemic control, duration of T1DM, family history of dyslipidemia and nutritional profile status. METHODS: Data of diagnostic information, comorbidities, birth weight, sex, family history of diabetes, dyslipidemia and heart diseases were reviewed. Anthropometric measurements, glycemic control, blood pressure (BP), lipid profile, and pharmacological treatment for dyslipidemia were obtained in four moments: after three months of diagnosis (t1), two (t2), five (t3), and ten (t4) years of illness. RESULTS: 228 patients (122 girls), mean age at diagnosis of 7.3 years, were included. In t3 and t4 there was a significant increase in BP elevation. Prevalence of dyslipidemia was 31.7% in t1, 33.7% in t2; 37.4% in t3; and in 63.6% in t4. There was a significant increase in total cholesterol and LDL-cholesterol level over time (p<0.001) and a significant increase in triglycerides levels only in t4 (p=0.002). CONCLUSION: Changes in lipid profile in children and adolescents with T1DM are prevalent, but they are undertreated, and the greater age, the greater probability of developing dyslipidemia. Thus, screening for dyslipidemia should be done and pharmacological treatment should be encouraged as recommended.

Figure 1 Oxidation of substrates 1h and 2h after insulin administration.