ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes
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The author declares that there is no conflict of interest. The peer review history for this article is available at https://publons.com/publon/10.1111/pedi.13429. There is no original data linked to this guideline.
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Glucose monitoring and nutrition management are foundational pillars of type 1 diabetes care and are essential for glycaemic control and preventing complications.
“Glucose monitoring and nutrition management are foundational pillars of type 1 diabetes care and are essential for glycaemic control and preventing complications.98,99”
From The future of type 1 diabetes therapy (2025) · cites this paper as [99]
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“(MUFA) and polyunsaturated fatty acids (PUFA) can be used as substitutes to improve the lipid profile (5).”
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ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents
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“%) instead of ISPAD targets ● NORMAL glucose is targeted as much as possible across all age groups.”
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“Per international guidelines, data do not currently support recommending very low carbohydrate diets ( 20–50 g/day) for youth with T1D, and the findings related to carbohydrate restriction are mixed [18].”
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“The cornerstones of DMT1 treatment are self-monitoring of blood glucose levels, insulin, and adequate nutrition [28–30].”
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“The International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend a macronutrient distribution consisting of 45–50% carbohydrates, less than 35% fat (with saturated fat 10%), and 15–20% protein [68].”
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“Insulin requirements are adjusted according to glycemic control, values that vary according to food intake, physical activity, menstrual cycle, or psychosocial variables [3–5].”
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“Guidelines now recommend that education on the glycemic impact of carbohydrate, fat, and protein be considered when calculating the mealtime insulin dose and delivery [8, 9].”
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“Barriers to PA and diet in those with TID include less metabolic flexibility during exercise [24–28], fear of exercise-associated hypoglycemia [29], and lack of specific recommendations for weight management for people with T1D [30].”
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“Similarly, the International Society for Pediatric and Adolescent Diabetes advocates individualized nutrition plans that ensure normal growth while maintaining glycemic targets [63].”
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“As of today, dietary recommendations for youth with T1D are based on general healthy eating principles, with the ISPAD advising a macronutrient distribution of 45–50% carbohydrates, less than 35% fat (including 10% saturated fat), and 15–20% protein [42].”
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“[23,24] .”
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“Real-time CGMS is now available as a valuable tool to monitor and reduce hyper and hypoglycemia [13, 14].”
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“In summary, the results are in line with previous findings [2,8] that the efficacy of ACC is not well established across all forms of insulin therapy, nor completely understood, but continues to be the method of choice in current guidelines [1].”
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“Optimal prandial practices were based on whether the child’s reported way of eating generally met the benchmarks for a healthful diet 1,2 and how well youth adhered with the recommended mealtime insulin administration practices (ie, pre-bolus dosing and carbohydrate/insulin matching).”
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Do the Types of Dietary Carbohydrate and Protein Affect Postprandial Glycemia in Type 1 Diabetes?
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“…the amount of carbohydrate consumed is the gold standard approach, however following a convincing body of evidence, current clinical guidelines now also advocate for protein and fat to be considered in the mealtime dosing algorithm, as well as nutrition education focused on dietary quality [1,2].”
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“9 In this population, reducing the complexity of meal insulin dose calculations via integration of standard (based on carbohydrate) automated bolus calculator (ABC) algorithms into glucose meters and insulin pumps has been shown to reduce treatment burden 10 and improve the accuracy 11 and…”
Teachers’ knowledge about the principles of dealing with a student with type 1 diabetes mellitus
Stefanowicz-Bielska, A., Miszk, M., & Rąpała, M. (2024) · BMC Public Health · doi:10.1186/s12889-024-20590-x · Cited by 3
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“The number of studies showing that low-CHO diets, which are not evidence-based but frequently used in nutrition therapy in type 1 diabetes mellitus (T1DM), improve glycemic outcomes and body weight control is limited [2,3].”
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Accuracy of ChatGPT, Gemini, Claude and DeepSeek in Carbohydrate Counting
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“Precision and reliability in carbohydrate calculation are key determinants of optimal postprandial glucose control and play a pivotal role in minimizing glycemic excursions [3].”
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“The daily diet of adolescents with T1DM should consist of balanced mixed meals that provide approximately 45% of total caloric intake from carbohydrates [15].”
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Nutritional myths in adolescents and young adults with type 1 diabetes: a pilot study
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“Personalized meal planning, cultural adaptations, and psychosocial considerations enhance glycemic control [25].”
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“2 Additionally, although physical activity was standardized for all participants, it may have in fl uenced postprandial glucose values.”
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Diagnostik, Therapie und Verlaufskontrolle des Typ-1-Diabetes mellitus im Kindes- und Jugendalter
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“…targets and glucose monitoring 28 ; insulin treatment 29 ; DKA 30 ; managing hypoglycemia 31 ; sick day management 32 ; exercise in adolescents with diabetes 33 ; complications and associated conditions with T1DM 34 ; nutritional management 35 ; and diabetes technologies and glucose monitoring.”
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“Although the strong evidence for nutritional needs in diabetic children, the scientific evidence basis for many elements of diabetic nutritional management is still developing 20 .”
Ceran, M. A., Keser, M. G., Bektaş, M., Unusan, N., & Eklioğlu, B. S. (2024) · Children · doi:10.3390/children11070779 · Cited by 2 · see citing works
“According to the International Society for Childhood and Adolescent Diabetes guidelines, the daily energy intake should be 45 to 50 per cent from carbohydrates, 30 to 35 per cent from fat (saturated fat 10 per cent), and 15 to 20 per cent from protein [3].”
MethodPedersen, Z. O., Jacobsen, S. S., Ewers, B., & Grabowski, D. (2024) · Nutrients · doi:10.3390/nu16111618 · Cited by 2 · see citing works
“ACC allows flexibility in carbohydrate intake and improves quality of life and glycemic control in children and adolescents with T1D [4].”
BackgroundMethodInfluentialSevere growth retardation during carbohydrate restriction in type 1 diabetes mellitus: A case report
Kawashima, S., Sogi, C., Kamimura, M., Kikuchi, A., & Kanno, J. (2024) · Clinical Pediatric Endocrinology · doi:10.1297/cpe.2024-0003 · Cited by 2
“As described in the 2022 guidelines, monitoring growth charts in children with T1DM at each clinic visit will assist in identifying changes in weight and height (2).”
Atik-Altınok, Y., Mansuroglu, Y., Demir, G., Balkı, H. G., Ozen, S., Darcan, S., & Goksen, D. (2024) · European Journal of Clinical Nutrition · doi:10.1038/s41430-024-01422-y · Cited by 2 · see citing works
“In addition, saturated fat intake was above, and fi ber intake was lower than the recommendations for both baseline and follow-up [3, 15].”
BackgroundInfluentialBanca, R. O. L., Volkening, L. K., Mehta, S. N., Dassau, E., & Laffel, L. M. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0464 · Cited by 5 · see citing works
Lim, R. J., Abraham, M., Nicholls, R., Fournier, P. A., & Harray, A. (2023) · Journal of Pediatric Endocrinology and Diabetes · doi:10.25259/jped_18_2023 · Cited by 2 · see citing works
Prasetyawati, A. E., Probandari, A. N., Claramita, M., & Julia, M. (2023) · Iranian Journal of Public Health · doi:10.18502/ijph.v52i7.13234 · Cited by 2 · see citing works
“lem-solving, nutrition, psychosocial, and behavioral management are needed to improve their quality of life (10,20,34,44).”
BackgroundPendhari, A. T., R., S. R. V., Bantwal, G., Kumar, K. M. P., Reddy, S., Kannan, S., & Reddy, M. M. (2026) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-026-01664-5 · Cited by 1 · see citing works
Patient, family and provider experiences with a very low-carbohydrate approach for type 1 diabetes
Azova, S., Gordon, E., Edwards, G., Henn, O., Ludwig, D. S., Garvey, K., & Lennerz, B. S. (2026) · Journal of metabolic health · doi:10.4102/jmh.v9i1.137 · Cited by 1 · see citing works
Jacobsen, S. S., Pedersen, Z. O., Nyholm-Christensen, E., & Ewers, B. (2026) · Nutrients · doi:10.3390/nu18050790 · Cited by 1
“The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines highlight the benefits of group-based, collaborative education, emphasizing the importance of involving the entire family in decision-making and implementing appropriate changes [23].”
Gökçe, T., Karakus, K. E., Mutlu, G. Y., Muradoğlu, S., Eviz, E., Can, E., Smart, C. E., Hatun, Ş., & Özel, H. G. (2025) · Nutrition and Diabetes · doi:10.1038/s41387-025-00392-9 · Cited by 1 · see citing works
Murphy, J., Rasmussen, C. L., Brazo-Sayavera, J., Damilola, A. V., Loredan, N. P., Oluwayomi, A., Sardinha, L. B., Wedderkopp, N., & Murtagh, E. (2025) · Annals of Human Biology · doi:10.1080/03014460.2025.2523764 · Cited by 1 · see citing works
“The model with triglycerides as an outcome was additionally adjusted for BMI, waist circumference, blood glucose and insulin sensitivity (Bassali et al. 2010; Friedemann et al. 2012; Rodríguez-Morán et al. 2017; Annan et al. 2022).”
Expert Consensus Statement on Simplified Glycemic Care in Patients With Type 2 Diabetes Mellitus
Sethi, B. K., Chowdhury, S., Jain, S. M., Zargar, A. H., Chadha, M. D., Bhattacharyya, A., Shaikh, S. S., Makkar, B. M., Chawla, M. S., Kalra, P., et al. (2025) · Cureus · doi:10.7759/cureus.87002 · Cited by 1 · see citing works
“…(pulses and lentils) [9] Fats: <30% (saturated fats: <10%, MUFA: 10% energy + any calories left from carbohydrate portion; PUFA-10 % of energy) [9,16,17] A systematic review and meta-analysis by Dudzik et al. [18] (13 studies) reported that MNT improved HbA1c (−0.30% (−0.49, −0.12)) and FBG…”
InfluentialCarbohydrate Counting in Type 1 Diabetes: Look Beyond Glycemic Control
Bhriguvanshi, A., & Bajpai, A. (2024) · Indian Journal of Pediatrics · doi:10.1007/s12098-024-05258-z · Cited by 1
Adherence to Dietary Recommendations in Children With Type 1 Diabetes: A Cross- Sectional Study
Kundu, K., Singh, P., & Seth, A. (2024) · Indian Pediatrics · doi:10.1007/s13312-024-3298-6 · Cited by 1
Kowalczyk-Korcz, E., Dymińska, M., & Szypowska, A. (2024) · Nutrients · doi:10.3390/nu16020263 · Cited by 1 · see citing works
“Despite the positive effects, the International Society for Pediatric and Adolescent Diabetes (ISPAD) do not recommend these types of diets for children because they are potentially inadequately nourished and may lead to growth and pubertal problems [1,3].”
BackgroundInfluentialHolder, M., Ziegler, R., Kamrath, C., Kluge, A., Kummer, S., Lange, K., & Reschke, F. (2026) · Diabetologie und Stoffwechsel · doi:10.1055/a-2874-3708
“Gegenmaßnahmen erforderlich ▪ Klinisch relevante Hypoglykämie: Glukose 54mg/ 93].”
Konstantinidi, M., Zaravinos-Tsakos, F., Giannakopoulos, G., Benetou, V., Loukou, I., Papadopoulou, A., Kanaka‐Gantenbein, C., & Kolaitis, G. A. (2026) · Dietetics · doi:10.3390/dietetics5040061
da Silva, D. F., & Marchioni, D. (2026) · Cadernos de Saúde Pública · doi:10.1590/0102-311xen054726
“…the International Society for Pediatric and Adolescent Diabetes (ISPAD) recognizes food insecurity as a social determinant that may compromise diabetes management in children and adolescents, especially in low-and middle-income countries characterized by pronounced social inequalities 34 .”
Oliveira, R., Martínez-Sanz, J. M., Lima, J. P. M., García-Poblet, M., & Sospedra, I. (2026) · Pediatric Reports · doi:10.3390/pediatric18050129
“These findings are consistent with family-systems perspectives and contemporary paediatric diabetes frameworks, which recognise diabetes management as embedded within relational and organisational contexts rather than as an individual behaviour alone [4,5,33,43,44].”
Wu, D.-Q., & Huang, D. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1850304
Arık, S. D., & Çetinkaya, S. (2026) · Journal of Pediatric Endocrinology & Metabolism (JPEM) · doi:10.1515/jpem-2026-0197
Kaya, D. G., Bayramoğlu, E., Turan, H., Evliyaoğlu, O., & Baş, M. (2026) · Nutrients · doi:10.3390/nu18172924
“Similarly, ISPAD nutritional guidance supports nutritional management tailored according to clinical context, treatment regimen, glycemic patterns, and patient needs, rather than a universal bedtime snack prescription [9].”
Papadopoulou, S. Κ., Angelakou, E.-P., Koimtsidis, T., Pavlidou, E., Tasoulas, D., & Giaginis, C. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1892085
“Managing body weight in children with diabetes requires balancing optimal glycemic control with adequate energy and nutrient intake to support normal growth, neurodevelopment, and pubertal maturation (93, 94).”
Adly, A., Ismail, E., Kader, M. S. A. A., Sadeq, M. R., & Salah, N. (2026) · Diabetologia · doi:10.1007/s00125-026-06835-x
Valdez, Y., Segev, N., Parimi, N., Vegesna, M., Brown, E. A., Samuels, S. L., Name, M. A. V., SHAH, A. S., & Wolf, R. M. (2026) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2026-0335
“Current pediatric guidance emphasizes nutrition, physical activity, and behavioral support alongside pharmacologic therapy [26].”
Johnson, J., Franklin, V. L., Shepherd, A. J., Allen, S., Blissitt, D., Keen, K., Maclean, K. M., McKillup, A.-M., Procter, E., Roach, S., et al. (2026) · Nutrients · doi:10.3390/nu18152536
Sharma, A., Sethi, A., Sharma, N., Sharma, U., & Shubham, S. (2026) · Cureus · doi:10.7759/cureus.114355
“…match prandial insulin doses to the carb content of meals using an individualized insulin-to-carb ratio [14], a recommendation retained in the updated 2022 ISPAD consensus guidelines, which further emphasize adapting carb-counting education to regional diets, foods, and available resources [15].”
Abdoul-Aziz, Doka, H. K., Abba, H. I. A., Hayatou, Z. T., Aissatou, G., Kouroutangou, P., & Sap, S. (2026) · Wiadomosci lekarskie · doi:10.36740/wlek/222499
Çağla, A. Y. E. R., Kaner, G., & Dündar, B. N. (2026) · Nutrition · doi:10.1016/j.nut.2026.113336
Marigliano, M., Piona, C. A., Morotti, E., Macedoni, M., Kharazizadeh, P., Mancioppi, V., Tomasselli, F., Tommasi, M., & Maffeis, C. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71135
“The participants' BMI-SDS was calculated according to WHO charts [18] and followed a standard nutrition education program based on ISPAD guidelines [19].”
Azova, S., Michelson, H., Williams, D., Lennerz, B. S., & Garvey, K. (2026) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106261450921
“1,2 29-31 As the diabetes care team plays a crucial role in supporting optimal self-management 36,37 in T1D, it is important to understand how early and longitudinal experiences with RDs, endocrinologists, and non-RD certified diabetes care and education specialists (CDCESs) impact the way patients and families approa…”
InfluentialNúñez-Baila, M., Gómez-Aragón, A., & González-López, J. (2026) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2026.105519
Yılmaz, M., Dikilitaş, S., Altınok, Y. A., & Gökşen, D. (2026) · Trends in Pediatrics · doi:10.59213/tp.2026.318
Afify, M. A. E. A., Taha, S., Kholy, E. M. E., & Salah, N. (2026) · Nutrients · doi:10.3390/nu18111802
“All participants were educated to follow an ordinary diet (dividing the total daily energy intake into 40–50% carbohydrate, 30–40% fat with no more than 10% saturated fat and trans fatty acids, and 15–25% proteins) according to the ISPAD 2022 guidelines [15].”
Prediabetes in children and adolescents: what do we need to know?
Jang, K. M., & Zeitler, P. S. (2026) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2550222.111
Smyczyńska, J., Mianowska, B., Pietrzak, I., Olejniczak, A., Suchowiński, M., Kopeć, K., Seliga, P., Smyczyńska, U., & Szadkowska, A. (2026) · Pediatric Endocrinology Diabetes and Metabolism · doi:10.5114/pedm.2026.162373
“Nutritional management is one of the key components of DM1 therapy, which includes appropriate macro-and micronutrients delivery, and maintenance of healthy body weight [3].”
Diabetes mellitus im Kindes- und Jugendalter (Update 2026)
Rami-Merhar, B., Fröhlich-Reiterer, E., Hofer, S., Meraner, D., Nagl, K., & Fritsch, M. (2026) · Wiener Klinische Wochenschrift · doi:10.1007/s00508-025-02650-3
“Neben der Berechnung der Kohlenhydrate zeigt die Berücksichtigung des glykämischen Index (GI) mit Be-vorzugung von Kohlenhydraten mit niedrigen GI positive Effekte auf die glykämische Kontrolle [19].”
Rohilla, L., Walia, P., Sahni, N., & Dayal, D. (2026) · International Journal of Clinical Nursing Research Society · doi:10.5005/ijcnrs-11024-0008
Lo, H. W. H., Chapleau, A., Morelli, P., Haines, J., Ball, G., & Lo, B. K. (2026) · Journal of human nutrition and dietetics (Print) · doi:10.1111/jhn.70243
Reiner, B. J. (2026) · Physician Assistant Clinics · doi:10.1016/j.cpha.2025.11.003
Alassaf, A. A., Gharaibeh, L., Ibrahim, S., Alkhalaileh, S., & Odeh, R. (2025) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2025-0510
Nutrition therapy in the era of automated insulin delivery
Talbo, M. K., Bishop, F. K., IGUDESMAN, D. A., Corbin, K. D., Sarteau, A. C., Mayer‐Davis, E. J., & Maahs, D. M. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1690486
- Authors
- Annan, S. F., Higgins, L. A., Jelleryd, E., Hannon, T., Rose, S., Salis, S., Baptista, J., Chinchilla, P., & Marcovecchio, M. L.
- Affiliations
- Paediatric Division University College London Hospitals London UK
- Joslin Diabetes Center (US)
- Karolinska University Hospital (SE)
- Indiana University Indianapolis (US)
- Diabetes & Endocrinology Service MidCentral District Health Board Palmerston North New Zealand
- Department of Nutrition Nurture Health Solutions Mumbai India
- Diabetes Training and Education Medtronic Sao Paulo Brazil
- London North West Healthcare NHS Trust (GB)
- University of Cambridge (GB)
- ORCID
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2022-12
- Volume
- 23
- Issue
- 8
- Pages
- 1297-1321
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W4310710096
- Cited by
- 143
- References
- 0
- Citations by year
- 2026: 37 · 2025: 41 · 2024: 34 · 2023: 24 · 2022: 1 · 2016: 5 · 2014: 1
- FWCI
- 18.52
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- dietary management, children, adolescents, diabetic diet
- MeSH terms
- Adolescent, Child, Diabetes Mellitus, Diabetes Mellitus, Type 1, Humans, Practice Patterns, Physicians', Societies, Medical, Age of Onset, Consensus
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